Provider Demographics
NPI:1861605941
Name:LLOYD, SUSAN MACKENZIE (DDS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MACKENZIE
Last Name:LLOYD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:MACKENZIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5100 S CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-2911
Mailing Address - Country:US
Mailing Address - Phone:386-304-2799
Mailing Address - Fax:386-304-2785
Practice Address - Street 1:5100 S CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-2911
Practice Address - Country:US
Practice Address - Phone:386-304-2799
Practice Address - Fax:386-304-2785
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00133231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice