Provider Demographics
NPI:1922202167
Name:CATHERINE L. LYLES DMD PA
Entity Type:Organization
Organization Name:CATHERINE L. LYLES DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:210-590-8858
Mailing Address - Street 1:13032 NACOGDOCHES RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-1981
Mailing Address - Country:US
Mailing Address - Phone:210-590-8858
Mailing Address - Fax:210-590-4981
Practice Address - Street 1:13032 NACOGDOCHES RD
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-1981
Practice Address - Country:US
Practice Address - Phone:210-590-8858
Practice Address - Fax:210-590-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX173491223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty