Individual
TODD L LACKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
4001 BALMORAL DR SW, HUNTSVILLE, AL 35801-6403
(256) 539-7447
(256) 534-1233
Mailing address
4001 BALMORAL DR SW, HUNTSVILLE, AL 35801-6403
(256) 539-7447
(256) 534-1233
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
4855
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
51092706
BC/BS ALABAMA
AL
Enumeration date
09/14/2006
Last updated
07/08/2007
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