Provider Demographics
NPI:1881760155
Name:LYMAN, JASON D (DMD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:D
Last Name:LYMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E IOWA
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:AZ
Mailing Address - Zip Code:86025
Mailing Address - Country:US
Mailing Address - Phone:928-524-6854
Mailing Address - Fax:928-524-1158
Practice Address - Street 1:407 E IOWA
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:AZ
Practice Address - Zip Code:86025
Practice Address - Country:US
Practice Address - Phone:928-524-6854
Practice Address - Fax:928-524-1158
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist