MEDICARE: LOCKE WHITE DENTAL ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	16440	MA
2	1223G0001X	General Practice Dentistry	9896	MA
3	1223G0001X	General Practice Dentistry	20769	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336157338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOCKE WHITE DENTAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	PO BOX 480
Second Line	:	529 NANTASKET AVE
City	:	HULL
State	:	MA
Zip	:	02045
Country	:	US
Telephone Number	:	781-925-5100
Fax Number	:	781-925-9791

Provider Business Practice Location Address
First Line	:	529 NANTASKET AVE
Second Line	:
City	:	HULL
State	:	MA
Zip	:	02045
Country	:	US
Telephone Number	:	781-925-5100
Fax Number	:	781-925-9791

Authorized Official
Title or Position	:	DENTIST OWNER
Name	:	STEPHEN A LOCKE
Credential	:	DMD
Telephone Number	:	781-925-5100

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	08/22/2020

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