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General NPI Number Information
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NPI Number | 1376388264
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Entity Type | Individual
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Provider Name | MARENA LOCKE COUNCE DDS
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Gender | Female
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Dates
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Enumeration Date | 07/01/2024
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 9035 E SANDIDGE RD STE 100
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City | OLIVE BRANCH
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State | MS
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Zip | 38654-3563
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Country | US
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Telephone | 662-731-0866
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Fax |
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Provider Business Mailing Address
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Address Line | 500 S GREER ST
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City | MEMPHIS
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State | TN
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Zip | 38111-3212
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Country | US
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Telephone | 901-258-2793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 112253
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12527
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License Number State | TN
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