Individual
JONATHAN TYLER LOCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6410 VETERANS AVE, BROOKLYN, NY 11234
(718) 531-4900
Mailing address
6410 VETERANS AVE, SUITE 205, BROOKLYN, NY 11234-5605
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
060769
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/07/2018
Last updated
09/17/2019
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