Individual
JACOB LYSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2012 S TOLLGATE RD STE 212, BEL AIR, MD 21015-5902
(443) 996-6691
Mailing address
151 WESTCHESTER HALL, STONY BROOK, NY 11794-8711
(631) 444-2557
(631) 444-6013
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
063929
NY
1223P0221X
Pediatric Dentistry
18381
MD
Other
Enumeration date
04/07/2022
Last updated
07/15/2025
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