Provider Demographics
NPI:1194536870
Name:LLOYD, JACKSON MATTHEW (DDS)
Entity type:Individual
Prefix:
First Name:JACKSON
Middle Name:MATTHEW
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 1:1050 PACKSADDLE TRL
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-9476
Mailing Address - Country:US
Mailing Address - Phone:972-838-3502
Mailing Address - Fax:
Practice Address - Street 1:1286 W VAN ALSTYNE PKWY
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-4390
Practice Address - Country:US
Practice Address - Phone:903-712-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41167122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist