| Michael Lysonski Dds Llc | |
|
1917 Old Us 66 Suite B-c-d1 Edgewood NM 87015-6799 | |
| (262) 391-6179 | |
| Not Available |
| Full Name | Michael Lysonski Dds Llc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1917 Old Us 66, Edgewood, New Mexico |
| Authorized Official Name and Position | Michael Lysonski (DR.) |
| Authorized Official Contact | 2623916179 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Lysonski Dds Llc 1520 La Tuna Pl Se Albuquerque NM 87123-4412 Ph: (262) 391-6179 | Michael Lysonski Dds Llc 1917 Old Us 66 Suite B-c-d1 Edgewood NM 87015-6799 Ph: (262) 391-6179 |
| NPI Number | 1427513902 |
|---|---|
| Provider Enumeration Date | 02/08/2019 |
| Last Update Date | 03/07/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427513902 | NPI | - | NPPES |
| 17933030 | Medicaid | NM | |
| DD4113 | Other | NM | NM DENTAL LICENSE |
| 03-426588-00-0 | Other | NM | NMCRS |
| CS00220539 | Other | NM | NM CONTROLLED SUBSTANCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
Edgewood Family Dentistry Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1917 Old Highway 66, Edgewood, NM 87015 Phone: 505-281-0373 Fax: 505-281-0373 | |
Zachcurriedds Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1851 Old Us 66 Ste C, Edgewood, NM 87015 Phone: 505-281-0373 |