MEDICARE: LYDIATT AND DURU FAMILY DENTISTRY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7736	CO

General Provider Information

NPI Number	:	1144390196
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYDIATT AND DURU FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	6665 DELMONICO DR
Second Line	:	SUITE C
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-6801
Country	:	US
Telephone Number	:	719-599-5700
Fax Number	:

Provider Business Practice Location Address
First Line	:	6665 DELMONICO DR
Second Line	:	SUITE C
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-6801
Country	:	US
Telephone Number	:	719-599-5700
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. JOHN S LYDIATT
Credential	:	D.D.S.
Telephone Number	:	719-599-5700

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	09/29/2015

Similar Medicare Providers

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Practice Location Address:

6665 DELMONICO DR , SUITE C
COLORADO SPRINGS, CO
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Practice Location Address:

6665 DELMONICO DR , STE. A
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1538452420 — JESSICA LYNN DURU D.D.S.
Practice Location Address:

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1114394186 — MS. DONNA VIE WALCHLI RDH
Practice Location Address:

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Practice Fax:

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