Provider Demographics
NPI:1699861336
Name:INDIGO DENTAL INC
Entity type:Organization
Organization Name:INDIGO DENTAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:386-253-3629
Mailing Address - Street 1:139 EXECUTIVE CIR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1198
Mailing Address - Country:US
Mailing Address - Phone:386-253-3629
Mailing Address - Fax:386-253-3620
Practice Address - Street 1:139 EXECUTIVE CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1198
Practice Address - Country:US
Practice Address - Phone:386-253-3629
Practice Address - Fax:386-253-3620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0013454261QD0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies