Provider Demographics
NPI:1992078794
Name:LOCKHART, LAUREN (DDS)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:LOCKHART
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 1:5340 W KENNEDY BLVD
Mailing Address - Street 2:APT. 342
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2404
Mailing Address - Country:US
Mailing Address - Phone:216-832-1125
Mailing Address - Fax:
Practice Address - Street 1:23680 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1571
Practice Address - Country:US
Practice Address - Phone:727-799-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-10
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 195671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics