Provider Demographics
NPI:1699798066
Name:LYLE, JOSEPH KIMBROUGH (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:KIMBROUGH
Last Name:LYLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 POPLAR AVE.
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3851
Mailing Address - Country:US
Mailing Address - Phone:901-767-3950
Mailing Address - Fax:901-767-7755
Practice Address - Street 1:5575 POPLAR AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3856
Practice Address - Country:US
Practice Address - Phone:901-767-3950
Practice Address - Fax:901-767-7755
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 2067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist