Provider Demographics
NPI:1134390156
Name:LYONS, JOHN FRANCIS JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANCIS
Last Name:LYONS
Suffix:JR
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 1:12 BENNINGTON ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128
Mailing Address - Country:US
Mailing Address - Phone:617-561-7600
Mailing Address - Fax:
Practice Address - Street 1:12 BENNINGTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128
Practice Address - Country:US
Practice Address - Phone:617-561-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9939122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0257125Medicaid