NPI: 1427513902 · EDGEWOOD, NM 87015 · General Practice Dentistry · NPI assigned 02/08/2019
| Authorized Official | LYSONSKI, MICHAEL (DR.) |
| NPI Enumeration Date | 02/08/2019 |
| Year | Claims | Total Paid |
|---|---|---|
| 2022 | 12 | $213.72 |
| 2023 | 12 | $213.72 |
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|---|---|---|---|
| D1208 | Topical application of fluoride, excluding varnish | 24 | 24 | $427.44 |