Provider Demographics
NPI:1477606226
Name:MARK LIDNER DDS PC
Entity Type:Organization
Organization Name:MARK LIDNER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:HERBERT
Authorized Official - Last Name:LIDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:623-972-7322
Mailing Address - Street 1:13203 N 103RD AVE
Mailing Address - Street 2:STE H 1
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351
Mailing Address - Country:US
Mailing Address - Phone:623-972-7322
Mailing Address - Fax:623-972-0283
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:STE H 1
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351
Practice Address - Country:US
Practice Address - Phone:623-972-7322
Practice Address - Fax:623-972-0283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2769122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty