Provider Demographics
NPI:1144390196
Name:LYDIATT AND DURU FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LYDIATT AND DURU FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:LYDIATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-599-5700
Mailing Address - Street 1:6665 DELMONICO DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-6801
Mailing Address - Country:US
Mailing Address - Phone:719-599-5700
Mailing Address - Fax:
Practice Address - Street 1:6665 DELMONICO DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-6801
Practice Address - Country:US
Practice Address - Phone:719-599-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO77361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty