Healthcare Provider Details

I. General information

NPI: 1114422664
Provider Name (Legal Business Name): LOCKHART DENTAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SOUTH COLORADO ST
LOCKHART TX
78644
US

IV. Provider business mailing address

PO BOX 674330
DALLAS TX
75267-4330
US

V. Phone/Fax

Practice location:
  • Phone: 940-220-7833
  • Fax: 855-731-5147
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number25735
License Number StateTX

VIII. Authorized Official

Name: CRAIG FLEMING COPELAND
Title or Position: OWNER
Credential: DMD
Phone: 940-220-7833