Healthcare Provider Details

I. General information

NPI: 1326203696
Provider Name (Legal Business Name): STEPHEN M LYON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 07/16/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 MAIN STREET SQUIRE HALL 240
BUFFALO NY
14214-6867
US

IV. Provider business mailing address

3435 MAIN STREET SQUIRE HALL 240
BUFFALO NY
14214-6867
US

V. Phone/Fax

Practice location:
  • Phone: 716-829-3602
  • Fax: 716-829-3501
Mailing address:
  • Phone: 716-829-3602
  • Fax: 716-829-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number1871
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number064587
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: