Healthcare Provider Details

I. General information

NPI: 1356984447
Provider Name (Legal Business Name): DR DIANNE WHITFIELD-LOCKE'S DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 MARLBORO PIKE
CAPITOL HEIGHTS MD
20743-5402
US

IV. Provider business mailing address

5105 MARLBORO PIKE
CAPITOL HEIGHTS MD
20743-5402
US

V. Phone/Fax

Practice location:
  • Phone: 301-420-1464
  • Fax: 301-735-0056
Mailing address:
  • Phone: 301-420-1464
  • Fax: 301-735-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: LAKEETHIA HAMMOND MCDONALD
Title or Position: MANAGER
Credential:
Phone: 301-420-1464