Individual
DR. MICHAEL LYSONSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7245-15
WI
122300000X
Dentist
Primary
DD4113
NM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/24/2014
Last updated
10/22/2014
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