Provider Demographics
NPI:1487064879
Name:LYERLY, MILLIE ALISON (DDS)
Entity type:Individual
Prefix:DR
First Name:MILLIE
Middle Name:ALISON
Last Name:LYERLY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FLYCATCHER WAY UNIT 204
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-5528
Mailing Address - Country:US
Mailing Address - Phone:704-239-4283
Mailing Address - Fax:
Practice Address - Street 1:10 FLYCATCHER WAY UNIT 204
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-5528
Practice Address - Country:US
Practice Address - Phone:704-239-4283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist