Provider Demographics
NPI:1184837932
Name:LOCKWOOD, STEPHEN EVERETT (DMD, MAGD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:EVERETT
Last Name:LOCKWOOD
Suffix:
Gender:M
Credentials:DMD, MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4150 REGENTS PARK ROW
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-9124
Mailing Address - Country:US
Mailing Address - Phone:858-558-3050
Mailing Address - Fax:858-558-3053
Practice Address - Street 1:4150 REGENTS PARK ROW
Practice Address - Street 2:SUITE 230
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-9124
Practice Address - Country:US
Practice Address - Phone:858-558-3050
Practice Address - Fax:858-558-3053
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0331201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice