Provider Demographics
NPI:1871020891
Name:NYE, ALEX LORD (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:LORD
Last Name:NYE
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 1:2061 SYCAMORE RD
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-2042
Mailing Address - Country:US
Mailing Address - Phone:815-862-2005
Mailing Address - Fax:815-748-3471
Practice Address - Street 1:1290 SALEM RD SW STE 10
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902-4210
Practice Address - Country:US
Practice Address - Phone:507-216-5863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist