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General NPI Number Information
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NPI Number | 1043315971
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Entity Type | Organization
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Legal Business Name | LYONS DENTAL CARE, LLC
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 05/09/2018
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Provider Practice Location Address
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Address Line | 220 W COMMERCIAL ST
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City | LYONS
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State | KS
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Zip | 67554-2716
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Country | US
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Telephone | 620-257-5193
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 696
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City | LYONS
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State | KS
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Zip | 67554-0696
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Country | US
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Telephone | 620-257-5193
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Fax |
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Authorized Official
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Title or Position | DR
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Name | MATTHEW AARON PERRY
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Credential | DMD
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Telephone | 620-257-5193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4387
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License Number State | KS
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