Individual
LISA M TYRA-HERRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
2 RUBIN DR, RUSHVILLE, NY 14544-9681
(585) 554-4400
Mailing address
2 RUBIN DR, RUSHVILLE, NY 14544-9681
(585) 554-4400
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
021312-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00618199
—
NY
Enumeration date
10/20/2009
Last updated
10/20/2009
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