Provider Demographics
NPI:1811553670
Name:HUNT, LYDIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:
Last Name:HUNT
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 1:231 WADE ROAD EXT UNIT 101
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1855
Mailing Address - Country:US
Mailing Address - Phone:518-573-5515
Mailing Address - Fax:
Practice Address - Street 1:231 WADE ROAD EXT UNIT 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1855
Practice Address - Country:US
Practice Address - Phone:518-782-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY061262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program