Provider Demographics
NPI:1871735589
Name:LYDIG DENTAL
Entity type:Organization
Organization Name:LYDIG DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:YAKOV
Authorized Official - Middle Name:
Authorized Official - Last Name:PILTSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-863-4777
Mailing Address - Street 1:2120 MATTHEWS AVE
Mailing Address - Street 2:1 FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-2637
Mailing Address - Country:US
Mailing Address - Phone:718-863-4777
Mailing Address - Fax:718-892-8884
Practice Address - Street 1:2120 MATTHEWS AVE
Practice Address - Street 2:1 FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-2637
Practice Address - Country:US
Practice Address - Phone:718-863-4777
Practice Address - Fax:718-892-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-26
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0406471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty