Provider Demographics
NPI:1679976864
Name:LOCKHART & LOCKHART, P.L.L.C.
Entity Type:Organization
Organization Name:LOCKHART & LOCKHART, P.L.L.C.
Other - Org Name:DUAL IMAGE ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-269-8495
Mailing Address - Street 1:2620 W ARROWOOD RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6199
Mailing Address - Country:US
Mailing Address - Phone:704-269-8495
Mailing Address - Fax:
Practice Address - Street 1:2620 W ARROWOOD RD
Practice Address - Street 2:SUITE 102
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6199
Practice Address - Country:US
Practice Address - Phone:704-269-8495
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty