Provider Demographics
NPI:1679552947
Name:MONK, LYDIA AZEALA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:AZEALA
Last Name:MONK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 CALOMEL DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-8786
Mailing Address - Country:US
Mailing Address - Phone:912-401-5276
Mailing Address - Fax:
Practice Address - Street 1:3960 CALOMEL DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8786
Practice Address - Country:US
Practice Address - Phone:912-401-5276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12888122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist