Healthcare Provider Details

I. General information

NPI: 1366828014
Provider Name (Legal Business Name): RHODA LOCKETT, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 E WOODMEN RD SUITE 200B
COLORADO SPRINGS CO
80920-3588
US

IV. Provider business mailing address

3210 E WOODMEN RD SUITE 200B
COLORADO SPRINGS CO
80920-3588
US

V. Phone/Fax

Practice location:
  • Phone: 719-358-6998
  • Fax: 719-358-6952
Mailing address:
  • Phone: 719-358-6998
  • Fax: 719-358-6952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9800
License Number StateCO

VIII. Authorized Official

Name: DR. RHODA L LOCKETT
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 240-338-2518