Provider Demographics
NPI:1700127073
Name:MARCUM, LLOYD H (DDS)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:H
Last Name:MARCUM
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 1:1129 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
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA323571223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics