Provider Demographics
NPI:1437114253
Name:DRYDEN, JOHN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:DRYDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1685 CROWN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-6322
Mailing Address - Country:US
Mailing Address - Phone:717-295-4400
Mailing Address - Fax:
Practice Address - Street 1:1685 CROWN AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6322
Practice Address - Country:US
Practice Address - Phone:717-295-4400
Practice Address - Fax:717-295-1389
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD55761223G0001X
PADS0377491223P0221X
NVS6-104C1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ645096Medicaid