Provider Demographics
NPI:1457427874
Name:LOCKWOOD, ROBIN RENETTE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:RENETTE
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 SW 119TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-3430
Mailing Address - Country:US
Mailing Address - Phone:405-703-4777
Mailing Address - Fax:405-703-4774
Practice Address - Street 1:2201 SW 119TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-3430
Practice Address - Country:US
Practice Address - Phone:405-703-4777
Practice Address - Fax:405-703-4774
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5610122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200030500AMedicaid