Active NPI
Larry G Lyles, DDS
- General Practice Dentistry
- Washington, DC
National Provider Identifier
1891784039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- Practice address
- 7603 Georgia Ave NW
Suite 403
Washington, DC 20012-1617 - Phone
- (202) 723-8284
- Fax
- (301) 990-1449
- NPI assigned
- Oct 20, 2005
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DC | Primary |
Addresses
Primary practice location
7603 Georgia Ave NW
Suite 403
Washington, DC 20012-1617
Mailing address
10506 Forestgate PL
Glenn Dale, MD 20769-2038
Phone (301) 809-0919
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 298941 | Other | DC | MAMSI |
| 39066-1 | Other | DC | DENTAL BENEFITS PROVIDER |
| 104722 | Other | DC | DORAL DENTAL |
| 8533 | Other | DC | BCBS OF MD |
| 783970 | Other | DC | UNITED CONCORDIA |
| 0800120 | Medicaid | DC |
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 |
|---|---|---|---|
| 734003547 | DC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1189382400000",
"number": "1891784039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10506 FORESTGATE PL",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207692038",
"telephone_number": "301-809-0919",
"fax_number": "301-805-9696"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7603 GEORGIA AVE NW",
"address_2": "SUITE 403",
"city": "WASHINGTON",
"state": "DC",
"postal_code": "200121617",
"telephone_number": "202-723-8284",
"fax_number": "301-990-1449"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LYLES",
"first_name": "LARRY",
"middle_name": "G",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-10-20",
"last_updated": "2007-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "DC",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "298941",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL BENEFITS PROVIDER",
"identifier": "39066-1",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL DENTAL",
"identifier": "104722",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF MD",
"identifier": "8533",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "783970",
"state": "DC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0800120",
"state": "DC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Washington, DC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.