Provider Demographics
NPI:1093972606
Name:LLOYD H DARBY, III DDS PC
Entity Type:Organization
Organization Name:LLOYD H DARBY, III DDS PC
Other - Org Name:DARBY DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:H
Authorized Official - Last Name:DARBY
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-537-3377
Mailing Address - Street 1:310 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-4708
Mailing Address - Country:US
Mailing Address - Phone:912-537-3377
Mailing Address - Fax:912-538-7010
Practice Address - Street 1:310 JACKSON ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-4708
Practice Address - Country:US
Practice Address - Phone:912-537-3377
Practice Address - Fax:912-538-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0068411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1801904131OtherNPI
GA=========OtherGENERAL DENTIST