Active NPI
Lisanne Lyle, DMD
- Dentist
- Philadelphia, PA
National Provider Identifier
1710862107
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS045398
- Practice address
- 1732 S Broad St
Philadelphia, PA 19145-2330 - Phone
- (215) 336-8391
- NPI assigned
- Aug 6, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS045398 | PA | Primary |
Addresses
Primary practice location
1732 S Broad St
Philadelphia, PA 19145-2330
Mailing address
1974 Dallas St
Philadelphia, PA 19138-2127
Phone (908) 210-4123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS045398 | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754438400000",
"number": "1710862107",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1974 DALLAS ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191382127",
"telephone_number": "908-210-4123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1732 S BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191452330",
"telephone_number": "215-336-8391"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYLE",
"first_name": "LISANNE",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-06",
"last_updated": "2025-08-06",
"certification_date": "2025-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS045398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.