Provider Demographics
NPI:1114078086
Name:HARANDIFASSIH, LYDA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:LYDA
Middle Name:
Last Name:HARANDIFASSIH
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 1:3362 PIEDMONT ROAD, N.E.
Mailing Address - Street 2:SUITE 1110
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-237-3070
Mailing Address - Fax:
Practice Address - Street 1:3365 PIEDMONT RD NE
Practice Address - Street 2:SUITE 1110
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1794
Practice Address - Country:US
Practice Address - Phone:404-237-3070
Practice Address - Fax:404-237-4561
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0114371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice