Provider Demographics
NPI:1013126648
Name:LYTLE, TATE & STAMPER, A DENTAL CORPORATION
Entity Type:Organization
Organization Name:LYTLE, TATE & STAMPER, A DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZAKARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-952-8183
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty