Provider Demographics
NPI:1841427887
Name:LOCKETT, RHODA L (DDS)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:L
Last Name:LOCKETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 AUSTIN BLUFFS PKWY #100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918
Mailing Address - Country:US
Mailing Address - Phone:719-304-5400
Mailing Address - Fax:719-304-5409
Practice Address - Street 1:3630 AUSTIN BLUFFS PKWY #100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918
Practice Address - Country:US
Practice Address - Phone:719-304-5400
Practice Address - Fax:719-304-5409
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO98001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9800OtherDENTAL LICENSE NUMBER