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NPI 1710040035

NPI 1710040035 : THOMAS EARL LOCKETT D.D.S : WASHINGTON, DC

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General NPI Number Information
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    NPI Number           |    1710040035
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    Entity Type          |    Individual 
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    Provider Name        |    THOMAS EARL LOCKETT D.D.S
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    12/18/2006
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    3020 14TH ST NW 
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    City                 |    WASHINGTON
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    State                |    DC
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    Zip                  |    20009-6865
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    Country              |    US
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    Telephone            |    202-745-4300
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    Fax                  |    202-232-0723
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Provider Business Mailing Address
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    Address Line         |    3020 14TH ST NW 
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    City                 |    WASHINGTON
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    State                |    DC
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    Zip                  |    20009-6865
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    Country              |    US
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    Telephone            |    202-745-4300
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    Fax                  |    202-232-0723
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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        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    DEN4395
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    License Number State |    DC
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