Provider Demographics
NPI:1225047111
Name:MAYNARD, HAROLD LLOYD (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LLOYD
Last Name:MAYNARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 EURY LN
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42501-4115
Mailing Address - Country:US
Mailing Address - Phone:606-678-8881
Mailing Address - Fax:606-678-8881
Practice Address - Street 1:29 EURY LN
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42501-4115
Practice Address - Country:US
Practice Address - Phone:606-678-8881
Practice Address - Fax:606-678-8881
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60067337Medicaid