Provider Demographics
NPI:1528586757
Name:BRETT, LYDIA LISA (DMD)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:LISA
Last Name:BRETT
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 1:324 HELMUTH LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-8667
Mailing Address - Country:US
Mailing Address - Phone:850-459-4657
Mailing Address - Fax:
Practice Address - Street 1:7764 ARMISTEAD RD STE 100
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-1918
Practice Address - Country:US
Practice Address - Phone:703-339-5091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014158181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice