Lydian Dental

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6107 Issued in AZ

Legal business name

LYDIAN DENTAL

Practice address

2010 E Elliot Rd Ste 105
Tempe, AZ 85284-1790

Phone

(480) 899-7996

Fax

(480) 752-3231

NPI assigned

Aug 14, 2018

Last updated

Aug 14, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Pamelyn D Buckhanan

Title

Insurance Coordinator

Phone

(480) 899-7996

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534204800000",
    "number": "1851871487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 E ELLIOT RD STE 105",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852841790",
            "telephone_number": "480-899-7996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 E ELLIOT RD STE 105",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852841790",
            "telephone_number": "480-899-7996",
            "fax_number": "480-752-3231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYDIAN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-14",
        "last_updated": "2018-08-14",
        "status": "A",
        "authorized_official_last_name": "BUCKHANAN",
        "authorized_official_first_name": "PAMELYN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "480-899-7996"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D6107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.