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General NPI Number Information
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NPI Number | 1811169071
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Entity Type | Organization
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Legal Business Name | C. MICHAEL LOCKE, D.M.D.,M.D.,PLC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 105 LEDFORD MILL RD STE A
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City | TULLAHOMA
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State | TN
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Zip | 37388-8262
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Country | US
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Telephone | 931-455-2105
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Fax | 931-455-2104
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Provider Business Mailing Address
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Address Line | 125 LEDFORD MILL RD
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City | TULLAHOMA
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State | TN
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Zip | 37388-2278
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Country | US
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Telephone | 931-455-2105
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Fax | 931-455-2104
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Authorized Official
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Title or Position | OWNER
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Name | DR. C. MICHAEL LOCKE
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Credential | D.M.D.,M.D.
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Telephone | 931-455-2105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DS0000007685
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License Number State | TN
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