Individual
DR. LARRY G LYLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7603 GEORGIA AVE NW, SUITE 403, WASHINGTON, DC 20012-1617
(202) 723-8284
(301) 990-1449
Mailing address
10506 FORESTGATE PL, GLENN DALE, MD 20769-2038
(301) 809-0919
(301) 805-9696
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0800120
—
DC
01
—
104722
DORAL DENTAL
DC
01
—
298941
MAMSI
DC
01
—
39066-1
DENTAL BENEFITS PROVIDER
DC
01
—
783970
UNITED CONCORDIA
DC
01
—
8533
BCBS OF MD
DC
Enumeration date
10/20/2005
Last updated
09/10/2007
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