Provider Demographics
NPI:1790924579
Name:LYERLY, WAYNE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:E
Last Name:LYERLY
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 1:5500 VETERANS MEMORIAL BLVD
Mailing Address - Street 2:SUITE 212
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70003-1750
Mailing Address - Country:US
Mailing Address - Phone:504-455-5252
Mailing Address - Fax:
Practice Address - Street 1:5500 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-1750
Practice Address - Country:US
Practice Address - Phone:504-455-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2653122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist