Basic Information
| Provider Information | |||||||||
| NPI: | 1841427887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LOCKETT | ||||||||
| FirstName: | RHODA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3630 AUSTIN BLUFFS PKWY #100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193045400 | ||||||||
| FaxNumber: | 7193045409 | ||||||||
| Practice Location | |||||||||
| Address1: | 3630 AUSTIN BLUFFS PKWY #100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80918 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193045400 | ||||||||
| FaxNumber: | 7193045409 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2009 | ||||||||
| LastUpdateDate: | 03/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223X0400X | 9800 | CO | Y | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics |
ID Information
| ID | Type | State | Issuer | Description | 9800 | 01 | CO | DENTAL LICENSE NUMBER | OTHER |