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General NPI Number Information
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NPI Number | 1093681132
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Entity Type | Organization
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Legal Business Name | LYON COLLEGE SCHOOL OF DENTAL MEDICINE
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 5 ALLIED DRIVE
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City | LITTLE ROCK
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State | AR
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Zip | 72202
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Country | US
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Telephone | 501-920-9669
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Fax |
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Provider Business Mailing Address
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Address Line | 5 ALLIED DRIVE
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City | LITTLE ROCK
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State | AR
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Zip | 72202
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Country | US
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Telephone | 501-920-9669
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Fax |
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Authorized Official
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Title or Position | DEAN
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Name | DR. BURKE SOFFE
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Credential | DMD
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Telephone | 702-595-8260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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