Provider Demographics
NPI:1205044799
Name:LOCKLEAR, CHERYL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:R
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:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:RED SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:28377-0231
Mailing Address - Country:US
Mailing Address - Phone:910-843-4262
Mailing Address - Fax:910-843-1238
Practice Address - Street 1:239 S. MAIN STREET
Practice Address - Street 2:
Practice Address - City:RED SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28377
Practice Address - Country:US
Practice Address - Phone:910-843-4262
Practice Address - Fax:910-843-1238
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC46591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC805789OtherUNITED CONCORDIA
NC890179WMedicaid
NC8995366Medicaid
NC805879OtherTRICARE
NC95366OtherBLUECROSS BLUESHIELD
NCZQG105OtherBCBS OF MASS
NC95366OtherNC STATE HEALTHPLAN