Provider Demographics
NPI:1467476184
Name:LYON, HENRY D (DDS)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:D
Last Name:LYON
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 1:2454 W GLENLORD RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9557
Mailing Address - Country:US
Mailing Address - Phone:269-428-2222
Mailing Address - Fax:269-428-4444
Practice Address - Street 1:2454 W GLENLORD RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9557
Practice Address - Country:US
Practice Address - Phone:269-428-2222
Practice Address - Fax:269-428-4444
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010125271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice