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Organization
SWEETGUMS DENTAL LLC
Active
Organization
SWEETGUMS DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LARETHA URETT LOCKHART DDS (OWNER/DENTIST)
(706) 507-9132
Entity
Organization
Contact information
Practice address
1435 54TH ST, SUITE 100A, COLUMBUS, GA 31904-4998
(706) 507-9132
(706) 507-9135
Mailing address
1435 54TH ST, SUITE 100A, COLUMBUS, GA 31904-4998
(706) 507-9132
(706) 507-9135
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN013438
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
355358613B
—
GA
Enumeration date
02/10/2011
Last updated
02/10/2011
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