Provider Demographics
NPI:1316395015
Name:HAINLEY, LYDIA ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:ELIZABETH
Last Name:HAINLEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:ELIZABETH
Other - Last Name:CIVELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:40 W WELLSBORO ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1411
Mailing Address - Country:US
Mailing Address - Phone:570-662-1945
Mailing Address - Fax:570-746-6006
Practice Address - Street 1:346 YORK AVE
Practice Address - Street 2:
Practice Address - City:TOWANDA
Practice Address - State:PA
Practice Address - Zip Code:18848-2021
Practice Address - Country:US
Practice Address - Phone:570-828-3992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist