Healthcare Provider Details

I. General information

NPI: 1043217714
Provider Name (Legal Business Name): BARRY DENIS LYON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7704 QUARTERFIELD RD
GLEN BURNIE MD
21061-4412
US

IV. Provider business mailing address

7704 QUARTERFIELD RD
GLEN BURNIE MD
21061-4412
US

V. Phone/Fax

Practice location:
  • Phone: 410-760-1212
  • Fax: 410-760-1422
Mailing address:
  • Phone: 410-760-1212
  • Fax: 410-760-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number06164
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: