Healthcare Provider Details

I. General information

NPI: 1093879553
Provider Name (Legal Business Name): MICHELE LORAINE PARKER-LOCKETT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 PATTERSON ST NE
WASHINGTON DC
20002-3334
US

IV. Provider business mailing address

40 PATTERSON ST NE
WASHINGTON DC
20002-3334
US

V. Phone/Fax

Practice location:
  • Phone: 202-478-4718
  • Fax: 202-478-0610
Mailing address:
  • Phone: 202-478-4718
  • Fax: 202-478-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDEN4364
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: