MEDICARE: LOCKHART ORAL SURGERY AND DENTAL IMPLANT CENTER, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1184411829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCKHART ORAL SURGERY AND DENTAL IMPLANT CENTER, PLLC

Provider Business Mailing Address
First Line	:	1070 SAD WILLOW PASS
Second Line	:
City	:	DRIFTWOOD
State	:	TX
Zip	:	78619-4488
Country	:	US
Telephone Number	:	818-430-6948
Fax Number	:

Provider Business Practice Location Address
First Line	:	1418 S COLORADO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-3940
Country	:	US
Telephone Number	:	737-732-6070
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DR. SALLY MOSER
Credential	:	DDS
Telephone Number	:	818-430-6948

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	04/24/2025

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