Healthcare Provider Details

I. General information

NPI: 1467533695
Provider Name (Legal Business Name): WALDA PAULITA LLOYD DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CHILDRENS WAY # 624
LITTLE ROCK AR
72202-3500
US

IV. Provider business mailing address

1 CHILDRENS WAY # 653
LITTLE ROCK AR
72202-3500
US

V. Phone/Fax

Practice location:
  • Phone: 501-364-1816
  • Fax: 501-364-8600
Mailing address:
  • Phone: 501-364-1100
  • Fax: 501-364-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4419
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number35015
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number4419
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: