Provider Demographics
NPI:1316008725
Name:UNI KIM LIDNER DDS PLLC
Entity Type:Organization
Organization Name:UNI KIM LIDNER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:UNI
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:LIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-972-5800
Mailing Address - Street 1:PO BOX 41728
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1728
Mailing Address - Country:US
Mailing Address - Phone:623-972-5800
Mailing Address - Fax:
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:H-1
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3028
Practice Address - Country:US
Practice Address - Phone:623-972-5800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5520261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental