Provider Demographics
NPI:1881090025
Name:LOCKWOOD COMMONS DENTAL CARE
Entity type:Organization
Organization Name:LOCKWOOD COMMONS DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MESIA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-251-3995
Mailing Address - Street 1:4222 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203
Mailing Address - Country:US
Mailing Address - Phone:941-251-3995
Mailing Address - Fax:
Practice Address - Street 1:4222 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203
Practice Address - Country:US
Practice Address - Phone:941-251-3995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty