Provider Demographics
NPI:1225882863
Name:BRADFORD J LOCKHART DDS APC
Entity Type:Organization
Organization Name:BRADFORD J LOCKHART DDS APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-542-0267
Mailing Address - Street 1:3409 W 12600 S STE 220
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7268
Mailing Address - Country:US
Mailing Address - Phone:801-542-0267
Mailing Address - Fax:
Practice Address - Street 1:3409 W 12600 S STE 220
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7268
Practice Address - Country:US
Practice Address - Phone:801-542-0267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental