Healthcare Provider Details

I. General information

NPI: 1336157338
Provider Name (Legal Business Name): LOCKE WHITE DENTAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 NANTASKET AVE
HULL MA
02045
US

IV. Provider business mailing address

PO BOX 480 529 NANTASKET AVE
HULL MA
02045
US

V. Phone/Fax

Practice location:
  • Phone: 781-925-5100
  • Fax: 781-925-9791
Mailing address:
  • Phone: 781-925-5100
  • Fax: 781-925-9791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16440
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9896
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20769
License Number StateMA

VIII. Authorized Official

Name: STEPHEN A LOCKE
Title or Position: DENTIST OWNER
Credential: DMD
Phone: 781-925-5100