Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 14891 | MD |
NPI | 1053546168 |
---|---|
Provider Name | Dr. Todd R Lyman |
First Address | Bel Air, MD 21015-5902 |
Second Address | Bel Air, MD 21015-5902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2009 |
Last Update Date | 21/04/2015 |