Provider Demographics
NPI:1487739884
Name:LLOYD, VINCENT MICHAEL (DDS)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:MICHAEL
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 1:132 RIVERSTONE TERRACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-1703
Mailing Address - Country:US
Mailing Address - Phone:770-720-3280
Mailing Address - Fax:770-720-2382
Practice Address - Street 1:132 RIVERSTONE TERRACE
Practice Address - Street 2:SUITE 100
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-1703
Practice Address - Country:US
Practice Address - Phone:770-720-3280
Practice Address - Fax:770-720-2382
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA514075414AMedicaid