Individual
LISANNE LYLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1732 S BROAD ST, PHILADELPHIA, PA 19145-2330
(215) 336-8391
Mailing address
1974 DALLAS ST, PHILADELPHIA, PA 19138-2127
(908) 210-4123
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DS045398
PA
Other
Enumeration date
08/06/2025
Last updated
08/06/2025
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