Provider Demographics
NPI:1508642059
Name:LAKEWOOD RANCH ORAL AND FACIAL SURGERY
Entity Type:Organization
Organization Name:LAKEWOOD RANCH ORAL AND FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:LOREN
Authorized Official - Last Name:LYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-212-2328
Mailing Address - Street 1:7170 UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240
Mailing Address - Country:US
Mailing Address - Phone:941-212-2328
Mailing Address - Fax:941-258-9546
Practice Address - Street 1:7170 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240
Practice Address - Country:US
Practice Address - Phone:941-212-2328
Practice Address - Fax:941-258-9546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty