Organization Name: | GLENN E. LOCKWOOD,DDS,PC |
NPI Number: | 1245456326 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLENN E. LOCKWOOD (PRESIDENT) |
Mailing Address: | 605 Marine Ave Kenai |
State: | AK US |
Postal Code: | 996116928 |
Phone Number: | 9072834875 |
Fax Number: | 9072839412 |
NPI Enumeration Date: | 04/18/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 925 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |