Individual provider Active NPI

Shradha Lyttle, D.D.S.

  • Dentist
  • Denton, TX
National Provider Identifier
1437572005
Registry record updated Jan 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
29077 Issued in TX
Practice address
2430 S Interstate 35 E # South
Suite 210
Denton, TX 76205-4986
Phone
(940) 387-2214
NPI assigned
Feb 1, 2014
Last updated
Jan 22, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 29077 TX Primary

Addresses

Primary practice location

2430 S Interstate 35 E # South
Suite 210
Denton, TX 76205-4986

Mailing address

2430 S Interstate 35 E Ste 210
Denton, TX 76205-4944
Phone (402) 452-8315

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150730013533 TX Order and Referring Only - DentistPractitioner - Dentist 2163736489

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
29077TXMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Lillian Miller Dental Dentist PastSince Jan 26, 2020 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1391212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1437572005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2430 S INTERSTATE 35 E STE 210",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762054944",
            "telephone_number": "402-452-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2430 S INTERSTATE 35 E # SOUTH",
            "address_2": "SUITE 210",
            "city": "DENTON",
            "state": "TX",
            "postal_code": "762054986",
            "telephone_number": "940-387-2214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYTTLE",
        "first_name": "SHRADHA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-01",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "29077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Denton, TX

Sources for this page

Verify at the official NPI Registry.