Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 0442000313 | VA |
NPI | 1023539301 |
---|---|
Provider Name | Dr. Denver James Lyons |
First Address | Midlothian, VA 23113 |
Second Address | Midlothian, VA 23113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2017 |
Last Update Date | 24/08/2021 |