Provider Demographics
NPI:1821367079
Name:LYON, GARY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:C
Last Name:LYON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3932 LONG BEACH BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2615
Mailing Address - Country:US
Mailing Address - Phone:562-427-3890
Mailing Address - Fax:
Practice Address - Street 1:3932 LONG BEACH BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2615
Practice Address - Country:US
Practice Address - Phone:562-427-3890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics