Healthcare Provider Details

I. General information

NPI: 1912605080
Provider Name (Legal Business Name): ALYSSA LOCKHART DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSSA LOCKHART WAGUESPACK

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 N HIGHWAY 190 STE 100
COVINGTON LA
70433-5010
US

IV. Provider business mailing address

509 N HIGHWAY 190 STE 100
COVINGTON LA
70433-5010
US

V. Phone/Fax

Practice location:
  • Phone: 985-718-1439
  • Fax:
Mailing address:
  • Phone: 985-718-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7593
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: