Provider Demographics
NPI:1477781862
Name:LYMAN FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:LYMAN FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:JEREMY
Authorized Official - Last Name:WORD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-423-9190
Mailing Address - Street 1:301 SPARTANBURG RD
Mailing Address - Street 2:
Mailing Address - City:LYMAN
Mailing Address - State:SC
Mailing Address - Zip Code:29365-1746
Mailing Address - Country:US
Mailing Address - Phone:864-439-1240
Mailing Address - Fax:864-439-1241
Practice Address - Street 1:301 SPARTANBURG RD
Practice Address - Street 2:
Practice Address - City:LYMAN
Practice Address - State:SC
Practice Address - Zip Code:29365-1746
Practice Address - Country:US
Practice Address - Phone:864-439-1240
Practice Address - Fax:864-439-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC43601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX4360Medicaid