Provider Demographics
NPI:1801918529
Name:SYROP, LISA LYNNE (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LYNNE
Last Name:SYROP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14405 SHELTER COVE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-2242
Mailing Address - Country:US
Mailing Address - Phone:804-864-7780
Mailing Address - Fax:804-864-7783
Practice Address - Street 1:14405 SHELTER COVE RD
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-2242
Practice Address - Country:US
Practice Address - Phone:804-864-7781
Practice Address - Fax:804-864-7783
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist