Provider Demographics
NPI:1164689212
Name:LYONS, ALEXIS DYANN
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:DYANN
Last Name:LYONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7916 PEBBLE BEACH DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-7790
Mailing Address - Country:US
Mailing Address - Phone:916-962-0577
Mailing Address - Fax:
Practice Address - Street 1:7916 PEBBLE BEACH DR
Practice Address - Street 2:SUITE 105
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-7790
Practice Address - Country:US
Practice Address - Phone:916-962-0577
Practice Address - Fax:916-962-0584
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA571821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics