Provider Demographics
NPI:1265547855
Name:LOCKHART, PHILIP BRUCE JR (DDS)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:BRUCE
Last Name:LOCKHART
Suffix:JR
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 1:8202 CLEARVISTA PKWY
Mailing Address - Street 2:BLDG 4 SUITE C
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1430
Mailing Address - Country:US
Mailing Address - Phone:317-849-9715
Mailing Address - Fax:317-849-9833
Practice Address - Street 1:8202 CLEARVISTA PKWY
Practice Address - Street 2:BLDG 4 SUITE C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1430
Practice Address - Country:US
Practice Address - Phone:317-849-9715
Practice Address - Fax:317-849-9833
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12008708A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice