# DENTISTS AT QUEEN CREEK, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lydian Dental QC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1528605649
- **Authorized official:** BRITTANY EDDY (CREDENTIALING MANAGER)
- **Authorized official phone:** (713) 869-4535

## Contact information

- **Practice address:** 21295 S ELLSWORTH LOOP RD, QUEEN CREEK, AZ 85142-9866
- **Practice address phone:** (480) 445-9188
- **Practice address fax:** (480) 526-8177
- **Mailing address:** 1046 WESTWOOD TRL, ONEIDA, NY 13421-4629
- **Mailing address phone:** (315) 761-9837

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 12/09/2019
- **Last updated:** 12/09/2019