Provider Demographics
NPI:1982054052
Name:LYON, ALICIA (DDS)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:LYON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 5TH ST
Mailing Address - Street 2:PO BOX 264
Mailing Address - City:OVERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68863-5377
Mailing Address - Country:US
Mailing Address - Phone:308-627-1739
Mailing Address - Fax:
Practice Address - Street 1:3135 W 22ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-8700
Practice Address - Country:US
Practice Address - Phone:308-440-7895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE73231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice