Provider Demographics
NPI:1376633487
Name:LOCKWOOD, JOY BONIFACIO (DDS)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:BONIFACIO
Last Name:LOCKWOOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:JOY
Other - Middle Name:REMIGIO
Other - Last Name:BONIFACIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:8590 RIO SAN DIEGO DR
Mailing Address - Street 2:#110
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-299-1122
Mailing Address - Fax:619-299-1163
Practice Address - Street 1:8590 RIO SAN DIEGO DR
Practice Address - Street 2:#110
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-299-1122
Practice Address - Fax:619-299-1163
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA501261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice