Healthcare Provider Details

I. General information

NPI: 1831928829
Provider Name (Legal Business Name): EDWARD L LOCKE MCALLISTER II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 20TH ST
JOPLIN MO
64804-0207
US

IV. Provider business mailing address

2001 W 20TH ST
JOPLIN MO
64804-0207
US

V. Phone/Fax

Practice location:
  • Phone: 417-623-1414
  • Fax:
Mailing address:
  • Phone: 417-623-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number2024029066
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: