Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 17349 | TX |
NPI | 1073546172 |
---|---|
Provider Name | Dr. Catherine Lynn Lyles |
First Address | San Antonio, TX 78217-1981 |
Second Address | San Antonio, TX 78217-1981 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 08/07/2007 |