Individual
CHARISA LOCKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
422 GIBSON LN, LOGSDEN, OR 97357-9713
(541) 961-4802
Mailing address
PO BOX 65, NEWPORT, OR 97365-0017
(541) 961-4802
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H4652
OR
Other
Enumeration date
08/20/2016
Last updated
08/20/2016
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