Provider Demographics
NPI:1316404775
Name:YIMER, LIDIA KIDIST (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIDIA
Middle Name:KIDIST
Last Name:YIMER
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 1:3206 RUECKERT AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2919
Mailing Address - Country:US
Mailing Address - Phone:703-992-5180
Mailing Address - Fax:
Practice Address - Street 1:406 N FRUITLAND BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7261
Practice Address - Country:US
Practice Address - Phone:410-845-2956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD167011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice