Provider Demographics
NPI:1093141319
Name:LOCKLEAR, ELAINE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MARIE
Last Name:LOCKLEAR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3385 BURNS RD
Mailing Address - Street 2:104
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4328
Mailing Address - Country:US
Mailing Address - Phone:561-626-9400
Mailing Address - Fax:
Practice Address - Street 1:3385 BURNS RD
Practice Address - Street 2:104
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4328
Practice Address - Country:US
Practice Address - Phone:561-626-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN133201223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics