Provider Demographics
NPI:1184411829
Name:LOCKHART ORAL SURGERY AND DENTAL IMPLANT CENTER, PLLC
Entity type:Organization
Organization Name:LOCKHART ORAL SURGERY AND DENTAL IMPLANT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-430-6948
Mailing Address - Street 1:1070 SAD WILLOW PASS
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-4488
Mailing Address - Country:US
Mailing Address - Phone:818-430-6948
Mailing Address - Fax:
Practice Address - Street 1:1418 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:LOCKHART
Practice Address - State:TX
Practice Address - Zip Code:78644-3940
Practice Address - Country:US
Practice Address - Phone:737-732-6070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty