Provider Demographics
NPI:1568510295
Name:DAVID, LYDIA ESTHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:ESTHER
Last Name:DAVID
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 1:442 PLAINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2628
Mailing Address - Country:US
Mailing Address - Phone:732-549-5640
Mailing Address - Fax:732-826-0261
Practice Address - Street 1:325 STATE ST
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-4117
Practice Address - Country:US
Practice Address - Phone:732-826-0210
Practice Address - Fax:732-826-0261
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013214001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice