Provider Demographics
NPI:1013391531
Name:LYONS, BRIDGET ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIDGET
Middle Name:ANN
Last Name:LYONS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 PONCE DE LEON PL NE
Mailing Address - Street 2:APT 516
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4158
Mailing Address - Country:US
Mailing Address - Phone:706-339-5564
Mailing Address - Fax:
Practice Address - Street 1:2090 DUNWOODY CLUB DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30350-5434
Practice Address - Country:US
Practice Address - Phone:770-998-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist