Provider Demographics
NPI:1346361342
Name:LOCKE, GARY (DDS)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:LOCKE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 VETERANS AVE
Mailing Address - Street 2:205
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5639
Mailing Address - Country:US
Mailing Address - Phone:718-531-4900
Mailing Address - Fax:718-251-4425
Practice Address - Street 1:6410 VETERANS AVE
Practice Address - Street 2:205
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5639
Practice Address - Country:US
Practice Address - Phone:718-531-4900
Practice Address - Fax:718-251-4425
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0403121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice