MEDICARE: PHILLIP LEE LOCKER JR. 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	376	AK

General Provider Information

NPI Number	:	1518988559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHILLIP LEE LOCKER JR. DDS

Provider Business Mailing Address
First Line	:	3401 DENALI ST
Second Line	:	STE 201
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-4034
Country	:	US
Telephone Number	:	907-561-8573
Fax Number	:	907-563-6094

Provider Business Practice Location Address
First Line	:	3401 DENALI ST
Second Line	:	STE 201
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-4034
Country	:	US
Telephone Number	:	907-561-8573
Fax Number	:	907-563-6094

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

Provider Enumeration Date	:	07/23/2006
Last Update Date	:	07/08/2007

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