MEDICARE: DR. KATHY M LYDIC DDS

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	30018030	OH

General Provider Information

NPI Number	:	1215108154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHY M LYDIC DDS

Provider Business Mailing Address
First Line	:	2533 FRANKSWAY ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4204
Country	:	US
Telephone Number	:	614-864-2466
Fax Number	:	614-864-2638

Provider Business Practice Location Address
First Line	:	2533 FRANKSWAY ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43232-4204
Country	:	US
Telephone Number	:	614-864-2466
Fax Number	:	614-864-2638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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