Provider Demographics
NPI:1770780330
Name:LYTLE, ADAM JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JAMES
Last Name:LYTLE
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 1:2119 64TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9409
Mailing Address - Country:US
Mailing Address - Phone:616-217-3632
Mailing Address - Fax:
Practice Address - Street 1:2119 64TH ST SW
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9409
Practice Address - Country:US
Practice Address - Phone:616-217-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019634122300000X, 1223S0112X
WV40901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist