MEDICARE: DR DIANNE WHITFIELD-LOCKE'S DENTAL

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	261QD0000X	Dental Clinic/Center
2	122300000X	Dentist

General Provider Information

NPI Number	:	1356984447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR DIANNE WHITFIELD-LOCKE'S DENTAL

Provider Business Mailing Address
First Line	:	5105 MARLBORO PIKE
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-5402
Country	:	US
Telephone Number	:	301-420-1464
Fax Number	:	301-735-0056

Provider Business Practice Location Address
First Line	:	5105 MARLBORO PIKE
Second Line	:
City	:	CAPITOL HEIGHTS
State	:	MD
Zip	:	20743-5402
Country	:	US
Telephone Number	:	301-420-1464
Fax Number	:	301-735-0056

Authorized Official
Title or Position	:	MANAGER
Name	:	LAKEETHIA HAMMOND MCDONALD
Credential	:
Telephone Number	:	301-420-1464

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/22/2019

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