Organization
C. MICHAEL LOCKE, D.M.D.,M.D.,PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. C. MICHAEL LOCKE D.M.D.,M.D. (OWNER)
(931) 455-2105
Entity
Organization
Contact information
Practice address
105 LEDFORD MILL RD STE A, TULLAHOMA, TN 37388-8262
(931) 455-2105
(931) 455-2104
Mailing address
125 LEDFORD MILL RD, TULLAHOMA, TN 37388-2278
(931) 455-2105
(931) 455-2104
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS0000007685
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3208948
—
TN
01
—
338420
UNITED CONCORDIA
TN
01
—
4013636
BLUE CROSS BLUE SHIELD
TN
01
—
79318
UPIN
TN
Enumeration date
03/27/2008
Last updated
12/02/2022
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