Provider Demographics
NPI:1396720827
Name:LYONS, RAY A (DDS,FADPD, DABSCD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:A
Last Name:LYONS
Suffix:
Gender:M
Credentials:DDS,FADPD, DABSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:LOS LUNAS COMMUNITY PROGRAM
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-1269
Mailing Address - Country:US
Mailing Address - Phone:505-222-0919
Mailing Address - Fax:
Practice Address - Street 1:7905 MARBLE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7886
Practice Address - Country:US
Practice Address - Phone:505-232-5710
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD13021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM8808OtherDELTA DENTAL
NM0007343702OtherAETNA
NM8942OtherBC/BS
NMS0014741010OtherHCH ADMINISTRATION
NM631452OtherUNITED CONCORDIA
NM0004093OtherDORAL DENTAL
NMK8599Medicaid