Individual
DANIS LYLE LAIZURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD,FAGD
Contact information
Practice address
2014 S HOWARD ST, WALLA WALLA, WA 99362-4532
(509) 525-4833
(509) 525-0832
Mailing address
2014 S HOWARD ST, WALLA WALLA, WA 99362-4532
(509) 525-4833
(509) 525-0832
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE0004946
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
911868526
T.I.N.
WA
01
—
DE0004946
STATE LICENSE
WA
Enumeration date
07/25/2006
Last updated
03/07/2023
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