Provider Demographics
NPI:1508176645
Name:KENNARD T. LLOYD, DDS P.A.
Entity Type:Organization
Organization Name:KENNARD T. LLOYD, DDS P.A.
Other - Org Name:CORNER STONE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:KENNARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:678-964-2148
Mailing Address - Street 1:3102 N MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-0020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3102 N MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-0020
Practice Address - Country:US
Practice Address - Phone:678-964-2148
Practice Address - Fax:770-761-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1992931471OtherINDIVIDUAL NPI #