Provider Demographics
NPI:1457579682
Name:LOCKHART, CHARLES F (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:F
Last Name:LOCKHART
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 1:4748 N MILWAUKEE AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-3629
Mailing Address - Country:US
Mailing Address - Phone:773-685-9339
Mailing Address - Fax:773-685-6202
Practice Address - Street 1:4748 N MILWAUKEE AVE
Practice Address - Street 2:STE 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-3629
Practice Address - Country:US
Practice Address - Phone:773-685-9339
Practice Address - Fax:773-685-6202
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL190146181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1053431981OtherGROUP TYPE II NPI
IL1063649770OtherGROUP TYPE II NPI
ILIL4803004Medicare PIN
IL1063649770OtherGROUP TYPE II NPI