Provider Demographics
NPI:1679631550
Name:LLOYD, DAVID G (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:G
Last Name:LLOYD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 W NORTH AVE STE 236
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2416
Mailing Address - Country:US
Mailing Address - Phone:414-453-1423
Mailing Address - Fax:414-453-1477
Practice Address - Street 1:10425 W NORTH AVE STE 236
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2416
Practice Address - Country:US
Practice Address - Phone:414-453-1423
Practice Address - Fax:414-453-1477
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice