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General NPI Number Information
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NPI Number | 1861605941
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Entity Type | Individual
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Provider Name | SUSAN MACKENZIE LLOYD D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 5100 S CLYDE MORRIS BLVD SUITE 200
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City | PORT ORANGE
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State | FL
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Zip | 32127-2911
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Country | US
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Telephone | 386-304-2799
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Fax | 386-304-2785
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Provider Business Mailing Address
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Address Line | 5100 S CLYDE MORRIS BLVD SUITE 200
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City | PORT ORANGE
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State | FL
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Zip | 32127-2911
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Country | US
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Telephone | 386-304-2799
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Fax | 386-304-2785
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN0013323
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License Number State | FL
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