Provider Demographics
NPI:1477542140
Name:LLOYD MARCUM DDS INC
Entity Type:Organization
Organization Name:LLOYD MARCUM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:H
Authorized Official - Last Name:MARCUM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:805-541-8231
Mailing Address - Street 1:1129 PACIFIC ST
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3301
Mailing Address - Country:US
Mailing Address - Phone:805-541-8731
Mailing Address - Fax:805-541-8047
Practice Address - Street 1:1129 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3301
Practice Address - Country:US
Practice Address - Phone:805-541-8731
Practice Address - Fax:805-541-8047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32357122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty