Provider Demographics
NPI:1215037445
Name:LOCKHART, TAMMI TAYLOR (DMD)
Entity Type:Individual
Prefix:DR
First Name:TAMMI
Middle Name:TAYLOR
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRANDON ROAD
Mailing Address - Street 2:SUITE W
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-323-9726
Mailing Address - Fax:662-323-9727
Practice Address - Street 1:100 BRANDON ROAD
Practice Address - Street 2:SUITE W
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-9726
Practice Address - Fax:662-323-9727
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3016-971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660245Medicaid
MS000660245Medicaid