Provider Demographics
NPI:1710193628
Name:LOCK, DOUGLAS NIGEL (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:NIGEL
Last Name:LOCK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8370 MORRO RD
Mailing Address - Street 2:
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-3927
Mailing Address - Country:US
Mailing Address - Phone:805-466-3646
Mailing Address - Fax:805-466-2837
Practice Address - Street 1:8370 MORRO RD
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-3927
Practice Address - Country:US
Practice Address - Phone:805-466-3646
Practice Address - Fax:805-466-2837
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA232131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice