Tyra-Herrick, Lisa M

Tyra-Herrick, Lisa M is an individual health care provider with primary practice located at 2 Rubin Dr , Rushville NY 14544-9681. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Tyra-Herrick, Lisa M can be contacted via phone (585) 554-4400.

Contact Information

Primary practice address
2 Rubin Dr Rushville NY 14544-9681
Phone: (585) 554-4400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Hygienist 124Q00000X 021312-1 New York

Profile Details

NPI number 1023344496
LBN Legal business name Tyra-Herrick, Lisa M
Credentials Registered Dental Hygienist (RDH)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 20th, 2009
Last updated Oct 20th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023344496 NPPES
New York MEDICAID 00618199

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