Active NPI
Lisa W Tyler, D.M.D.
- Endodontics
- East Greenwich, RI
National Provider Identifier
1972648020
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 2494
- Practice address
- 63 Cedar Ave Unit 12
East Greenwich, RI 02818-3192 - Phone
- (401) 284-3500
- Fax
- (401) 284-3502
- NPI assigned
- Feb 20, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 2494 | RI | Primary |
Addresses
Primary practice location
63 Cedar Ave Unit 12
East Greenwich, RI 02818-3192
Mailing address
63 Cedar Ave Unit 12
East Greenwich, RI 02818-3192
Phone (401) 284-3500
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 |
|---|---|---|---|
| 2494 | RI | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Petra Diagnostics | Past | 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 and National Provider Directory roles.
-
- Dental Clinic/Center
- Narragansett, RI
- NPI 1881827780
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661904000000",
"number": "1972648020",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 CEDAR AVE UNIT 12",
"city": "EAST GREENWICH",
"state": "RI",
"postal_code": "028183192",
"telephone_number": "401-284-3500",
"fax_number": "401-284-3502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "63 CEDAR AVE UNIT 12",
"city": "EAST GREENWICH",
"state": "RI",
"postal_code": "028183192",
"telephone_number": "401-284-3500",
"fax_number": "401-284-3502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TYLER",
"first_name": "LISA",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2022-08-31",
"certification_date": "2022-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "RI",
"license": "2494",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in East Greenwich, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.