Provider Demographics
NPI:1528208766
Name:TAPIJA, LYDRA (DMD)
Entity Type:Individual
Prefix:
First Name:LYDRA
Middle Name:
Last Name:TAPIJA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 WILLIAMSBRIDGE RD
Mailing Address - Street 2:SUITE 1 H
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1619
Mailing Address - Country:US
Mailing Address - Phone:718-792-1000
Mailing Address - Fax:718-792-3672
Practice Address - Street 1:2130 WILLIAMSBRIDGE RD
Practice Address - Street 2:SUITE 1 H
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1619
Practice Address - Country:US
Practice Address - Phone:718-792-1000
Practice Address - Fax:718-792-3672
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-28
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052547122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist