Provider Demographics
NPI:1245456326
Name:GLENN E. LOCKWOOD,DDS,PC
Entity type:Organization
Organization Name:GLENN E. LOCKWOOD,DDS,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LOCKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-283-4875
Mailing Address - Street 1:605 MARINE AVE
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6928
Mailing Address - Country:US
Mailing Address - Phone:907-283-4875
Mailing Address - Fax:907-283-9412
Practice Address - Street 1:605 MARINE AVE
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6928
Practice Address - Country:US
Practice Address - Phone:907-283-4875
Practice Address - Fax:907-283-9412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK925261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental