MEDICARE: DR. ALEX LORD NYE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019031118	IL

General Provider Information

NPI Number	:	1871020891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEX LORD NYE DMD

Provider Business Mailing Address
First Line	:	2061 SYCAMORE RD
Second Line	:
City	:	DEKALB
State	:	IL
Zip	:	60115-2042
Country	:	US
Telephone Number	:	815-862-2005
Fax Number	:	815-748-3471

Provider Business Practice Location Address
First Line	:	1290 SALEM RD SW STE 10
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55902-4210
Country	:	US
Telephone Number	:	507-216-5863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	08/28/2021

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