Provider Demographics
NPI:1265003925
Name:LYM, ALVIN LORENO (DMD)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:LORENO
Last Name:LYM
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 S NEVADA ST APT F
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3394
Mailing Address - Country:US
Mailing Address - Phone:858-922-4356
Mailing Address - Fax:
Practice Address - Street 1:1102 NE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5701
Practice Address - Country:US
Practice Address - Phone:503-408-8927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist