Provider Demographics
NPI:1558371377
Name:LLOYD, SPENCER JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:JAMES
Last Name:LLOYD
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 1:4012 BRIAN AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83605-6305
Mailing Address - Country:US
Mailing Address - Phone:208-459-4312
Mailing Address - Fax:208-459-9059
Practice Address - Street 1:4012 BRIAN AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:ID
Practice Address - Zip Code:83605-6305
Practice Address - Country:US
Practice Address - Phone:208-459-4312
Practice Address - Fax:208-459-9059
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD33961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice