Provider Demographics
NPI:1689770869
Name:LYTLE, ROBERT JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:LYTLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1370 FOOTHILL BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2150
Mailing Address - Country:US
Mailing Address - Phone:818-952-8183
Mailing Address - Fax:818-952-6437
Practice Address - Street 1:1370 FOOTHILL BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2150
Practice Address - Country:US
Practice Address - Phone:818-952-8183
Practice Address - Fax:818-952-6437
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA520821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery