MEDICARE: GARY LOCKE DDS

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	040312	NY

General Provider Information

NPI Number	:	1346361342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LOCKE DDS

Provider Business Mailing Address
First Line	:	6410 VETERANS AVE
Second Line	:	205
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5639
Country	:	US
Telephone Number	:	718-531-4900
Fax Number	:	718-251-4425

Provider Business Practice Location Address
First Line	:	6410 VETERANS AVE
Second Line	:	205
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5639
Country	:	US
Telephone Number	:	718-531-4900
Fax Number	:	718-251-4425

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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1215058227 — RICHARD LOCKE DDS
Practice Location Address:

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Practice Phone: 718-531-4900
Practice Fax: 718-251-4425

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