1508176645 NPI number — KENNARD T. LLOYD, DDS P.A.

Table of content: (NPI 1508176645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508176645 NPI number — KENNARD T. LLOYD, DDS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNARD T. LLOYD, DDS P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508176645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3102 N MAIN ST
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
HOPE MILLS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28348-0020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3102 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
HOPE MILLS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28348-0020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-964-2148
Provider Business Practice Location Address Fax Number:
770-761-0490
Provider Enumeration Date:
10/07/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LLOYD
Authorized Official First Name:
KENNARD
Authorized Official Middle Name:
T
Authorized Official Title or Position:
OWNER/DENTIST
Authorized Official Telephone Number:
678-964-2148

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7713 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1992931471 . This is a "INDIVIDUAL NPI #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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