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Organization
LYDIAN DENTAL BURNET PLLC
Active
Organization
LYDIAN DENTAL BURNET PLLC
Active
Other names
Burnet Road Family Dental
Organization subpart
No
Provider details
NPI number
Authorized official
PAM BUCKHANAN (INSURANCE COORDINATOR)
(480) 560-5183
Entity
Organization
Contact information
Practice address
5531 BURNET RD, AUSTIN, TX 78756
(480) 560-5183
Mailing address
5531 BURNET RD, AUSTIN, TX 78756
(480) 560-5183
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5904
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144355629
NPI
AZ
Enumeration date
02/06/2018
Last updated
02/06/2018
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