Provider Demographics
NPI:1386239002
Name:STANLEY, LYDIA (RDH)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:STANLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LYDIA
Other - Middle Name:
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:U.S.A DENTAL HEALTH ACTIIVITY
Mailing Address - Street 2:4301 WILSON ST , OFFICE GD152
Mailing Address - City:FORT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503
Mailing Address - Country:US
Mailing Address - Phone:580-442-5925
Mailing Address - Fax:
Practice Address - Street 1:U.S.A DENTAL HEALTH ACTIIVITY
Practice Address - Street 2:652 HAMILIMTON RD, HEADQUARTERS
Practice Address - City:FORT.SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-442-5925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1672124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist