Provider Demographics
NPI:1881166429
Name:HENRY D LYON DDS PC
Entity type:Organization
Organization Name:HENRY D LYON DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LYON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:269-428-2222
Mailing Address - Street 1:2454 W GLENLORD RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49127-9557
Mailing Address - Country:US
Mailing Address - Phone:269-428-2222
Mailing Address - Fax:
Practice Address - Street 1:2454 W GLENLORD RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49127-9557
Practice Address - Country:US
Practice Address - Phone:269-428-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental