Lydian Dental Queen Creek, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D009270 Issued in AZ

Legal business name

LYDIAN DENTAL QUEEN CREEK, LLC

Practice address

21295 S Ellsworth Loop Rd Ste 103
Queen Creek, AZ 85142-9867

Phone

(480) 445-9188

Fax

(480) 526-8177

NPI assigned

Jun 19, 2018

Organization subpart

No

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

Authorized official

Name

Mrs. Pam D Buckhanan

Title

Insurance Coordinator

Phone

(480) 445-9188

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sunshine Lee, DMD

  • Dentist
  • Queen Creek, AZ
  • NPI 1194403691
  NPD (past)

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

{
    "created_epoch": "1529366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529366400000",
    "number": "1972097392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21295 S ELLSWORTH LOOP RD STE 103",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851429867",
            "telephone_number": "480-445-9188",
            "fax_number": "480-526-8177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21295 S ELLSWORTH LOOP RD STE 103",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851429867",
            "telephone_number": "480-445-9188",
            "fax_number": "480-526-8177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYDIAN DENTAL QUEEN CREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-19",
        "last_updated": "2018-06-19",
        "status": "A",
        "authorized_official_last_name": "BUCKHANAN",
        "authorized_official_first_name": "PAM",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "INSURANCE COORDINATOR",
        "authorized_official_telephone_number": "480-445-9188",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D009270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kelsey Madden, FNP

• General Practice Dentistry in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.