Individual provider Active NPI

Michael Lydick, D.D.S.

  • General Practice Dentistry
  • Indianapolis, IN
National Provider Identifier
1063490332
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12007558 Issued in IN
Practice address
8939 E 38TH St
#23
Indianapolis, IN 46226-6032
Phone
(317) 898-2822
NPI assigned
Jan 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 12007558 IN Primary

Addresses

Primary practice location

8939 E 38TH St
#23
Indianapolis, IN 46226-6032

Mailing address

8939 E 38TH St
#23
Indianapolis, IN 46226-6032
Phone (317) 898-2822

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160523002429 IN Order and Referring Only - DentistPractitioner - Dentist 7618266180

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12007558INMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1063490332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8939 E 38TH ST",
            "address_2": "#23",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462266032",
            "telephone_number": "317-898-2822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8939 E 38TH ST",
            "address_2": "#23",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462266032",
            "telephone_number": "317-898-2822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYDICK",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12007558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.