Provider Demographics
NPI:1710942214
Name:LYALL, SCOT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:EDWARD
Last Name:LYALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:7 GORWIN DR
Mailing Address - City:HANSON
Mailing Address - State:MA
Mailing Address - Zip Code:02341-0127
Mailing Address - Country:US
Mailing Address - Phone:781-293-2128
Mailing Address - Fax:781-294-4948
Practice Address - Street 1:7 GORWIN DR
Practice Address - Street 2:
Practice Address - City:HANSON
Practice Address - State:MA
Practice Address - Zip Code:02341-0127
Practice Address - Country:US
Practice Address - Phone:781-293-2128
Practice Address - Fax:781-294-4948
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist