MEDICARE: DR. ROBIN RENETTE LOCKWOOD DDS

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	122300000X	Dentist	5610	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457427874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBIN RENETTE LOCKWOOD DDS

Provider Business Mailing Address
First Line	:	2201 SW 119TH ST
Second Line	:	SUITE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-3430
Country	:	US
Telephone Number	:	405-703-4777
Fax Number	:	405-703-4774

Provider Business Practice Location Address
First Line	:	2201 SW 119TH ST
Second Line	:	SUITE A
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73170-3430
Country	:	US
Telephone Number	:	405-703-4777
Fax Number	:	405-703-4774

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	02/11/2011

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