Individual
DR. DANIEL D LYDIATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8303 DODGE ST, OMAHA, NE 68114-4108
(402) 354-5048
(402) 354-2585
Mailing address
PO BOX 10190, VIRGINIA BEACH, VA 23450-0190
(800) 477-5240
(757) 463-6572
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
16395
NE
207Y00000X
Otolaryngology Physician
16395
NE
2085R0001X
Radiation Oncology Physician
16395
NE
208600000X
Surgery Physician
Primary
16395
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10025044400
—
NE
05
—
1417913302
—
IA
Enumeration date
04/21/2006
Last updated
12/13/2013
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