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General NPI Number Information
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NPI Number | 1871020891
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Entity Type | Individual
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Provider Name | ALEX LORD NYE DMD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 08/28/2021
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Provider Practice Location Address
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Address Line | 1290 SALEM RD SW STE 10
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City | ROCHESTER
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State | MN
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Zip | 55902-4210
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Country | US
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Telephone | 507-216-5863
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Fax |
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Provider Business Mailing Address
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Address Line | 2061 SYCAMORE RD
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City | DEKALB
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State | IL
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Zip | 60115-2042
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Country | US
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Telephone | 815-862-2005
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Fax | 815-748-3471
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019031118
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License Number State | IL
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