Provider Demographics
NPI:1528556800
Name:B AND L LOCKHART, P.L.L.C
Entity Type:Organization
Organization Name:B AND L LOCKHART, P.L.L.C
Other - Org Name:DUAL IMAGE DENTISTRY AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:704-334-6907
Mailing Address - Street 1:2620 W ARROWOOD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6262
Mailing Address - Country:US
Mailing Address - Phone:704-269-8495
Mailing Address - Fax:
Practice Address - Street 1:1315 MATHESON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28205-1670
Practice Address - Country:US
Practice Address - Phone:704-334-6907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1578842001OtherNPI
NC1316280670OtherNPI