Provider Demographics
NPI:1902948334
Name:LOCKHART, ALISON W (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:W
Last Name:LOCKHART
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6906
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260-6906
Mailing Address - Country:US
Mailing Address - Phone:803-782-9030
Mailing Address - Fax:803-790-0294
Practice Address - Street 1:5107 TRENHOLM RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4802
Practice Address - Country:US
Practice Address - Phone:803-782-9030
Practice Address - Fax:803-790-0294
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice