Provider Demographics
NPI:1710180427
Name:LYDEN, SARAH (DDS)
Entity Type:Individual
Prefix:MISS
First Name:SARAH
Middle Name:
Last Name:LYDEN
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 1:33 CENTENNIAL ST
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-1205
Mailing Address - Country:US
Mailing Address - Phone:410-493-4987
Mailing Address - Fax:
Practice Address - Street 1:2300 BEL AIR RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2749
Practice Address - Country:US
Practice Address - Phone:410-493-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA043467122300000X
NC1505611223G0001X
MD14043122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC66159UMedicare UPIN