| NPI | 1528605649 |
|---|---|
| Former Legal Business Name | LYDIAN DENTAL QC |
| Entity Type | Organization |
| Authorized Contact | BRITTANY EDDY Credentialing Manager 713-869-4535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-12-09 |
| Last Update Date | 2019-12-09 |