Healthcare Provider Details

I. General information

NPI: 1063551414
Provider Name (Legal Business Name): JAMES RICHARD LLOYD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S HIGHLAND SPRINGS AVE SUITE 2L
BANNING CA
92220-6500
US

IV. Provider business mailing address

300 S HIGHLAND SPRINGS AVE SUITE 2L
BANNING CA
92220-6500
US

V. Phone/Fax

Practice location:
  • Phone: 951-769-7158
  • Fax: 951-769-7160
Mailing address:
  • Phone: 951-769-7158
  • Fax: 951-769-7160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number34872
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: