Healthcare Provider Details

I. General information

NPI: 1912347212
Provider Name (Legal Business Name): LYONS & RAWLINS DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 02/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 LAGUNA BLVD
ELK GROVE CA
95758-4148
US

IV. Provider business mailing address

PO BOX 4785
EL DORADO HILLS CA
95762-0024
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-7873
  • Fax:
Mailing address:
  • Phone: 916-229-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TIMOTHY LYONS
Title or Position: PRESIDENT
Credential: DDS
Phone: 916-442-7873