Provider Demographics
NPI:1417063363
Name:WHITFIELD LOCKE, DIANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:
Last Name:WHITFIELD LOCKE
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 1:5105 MARLBORO PIKE
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-5402
Mailing Address - Country:US
Mailing Address - Phone:301-420-1464
Mailing Address - Fax:301-420-8338
Practice Address - Street 1:5105 MARLBORO PIKE
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-5402
Practice Address - Country:US
Practice Address - Phone:301-420-1464
Practice Address - Fax:301-420-8338
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD9229122300000X
DC4518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016747900Medicaid