Provider Demographics
NPI:1528267838
Name:LIDNER, UNI KIM (DDS)
Entity type:Individual
Prefix:
First Name:UNI
Middle Name:KIM
Last Name:LIDNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:UNI
Other - Middle Name:
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:PO BOX 41728
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85080-1728
Mailing Address - Country:US
Mailing Address - Phone:602-622-6955
Mailing Address - Fax:
Practice Address - Street 1:13203 N 103RD AVE
Practice Address - Street 2:H-1
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3028
Practice Address - Country:US
Practice Address - Phone:623-972-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5520122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist