=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700473758
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LYONS TEETH AND BRACES A PROFESSIONAL PARTNERSHIP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2020
-----------------------------------------------------
Last Update Date | 12/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23033 LYONS AVE STE 5
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-255-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23033 LYONS AVE STE 5
-----------------------------------------------------
City | NEWHALL
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91321-2776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-255-0400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AILEEN NGAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 661-255-0400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------