Provider Demographics
NPI:1639152226
Name:LOCKAWICH, DOUGLAS EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:EDWARD
Last Name:LOCKAWICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:EDWARD
Other - Last Name:LOCKAWICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:603 CRESCENT AVE
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-1945
Mailing Address - Country:US
Mailing Address - Phone:724-758-4501
Mailing Address - Fax:
Practice Address - Street 1:603 CRESCENT AVE
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-1945
Practice Address - Country:US
Practice Address - Phone:724-758-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020149L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice