# C. MICHAEL LOCKE, D.M.D.,M.D.,PLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811169071
- **Authorized official:** DR. C. MICHAEL LOCKE D.M.D.,M.D. (OWNER)
- **Authorized official phone:** (931) 455-2105

## Contact information

- **Practice address:** 105 LEDFORD MILL RD STE A, TULLAHOMA, TN 37388-8262
- **Practice address phone:** (931) 455-2105
- **Practice address fax:** (931) 455-2104
- **Mailing address:** 125 LEDFORD MILL RD, TULLAHOMA, TN 37388-2278
- **Mailing address phone:** (931) 455-2105
- **Mailing address fax:** (931) 455-2104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | DS0000007685 | TN | Yes |

## Other

- **Enumeration date:** 03/27/2008
- **Last updated:** 12/02/2022