Individual provider Active NPI

Lisa Marie Tyler, D.D.S.

  • General Practice Dentistry
  • Fairview Park, OH
National Provider Identifier
1609086776
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19478 Issued in OH
Practice address
20997 Lorain Rd
Fairview Park, OH 44126-2030
Phone
(440) 333-6283
NPI assigned
May 23, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19478 OH Primary

Addresses

Primary practice location

20997 Lorain Rd
Fairview Park, OH 44126-2030

Mailing address

20997 Lorain Rd
Fairview Park, OH 44126-2030
Phone (440) 333-6283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20161121002777 OH Order and Referring Only - DentistPractitioner - Dentist 9133408842

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19478OHMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609086776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20997 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441262030",
            "telephone_number": "440-333-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20997 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441262030",
            "telephone_number": "440-333-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYLER",
        "first_name": "LISA",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "19478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview Park, OH

Sources for this page

Verify at the official NPI Registry.