Provider Demographics
NPI:1891197612
Name:LYON, TERESA DAWAHARE (DMD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:DAWAHARE
Last Name:LYON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:A
Other - Last Name:DAWAHARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:800 ROSE STREET, RM. D104
Mailing Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-323-9707
Mailing Address - Fax:859-257-5859
Practice Address - Street 1:800 ROSE STREET, RM. D104
Practice Address - Street 2:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:859-323-9707
Practice Address - Fax:859-257-5859
Is Sole Proprietor?:No
Enumeration Date:2014-09-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY63461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice