Provider Demographics
NPI:1518988559
Name:LOCKER, PHILLIP LEE JR (DDS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LEE
Last Name:LOCKER
Suffix:JR
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 1:3401 DENALI ST
Mailing Address - Street 2:STE 201
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4034
Mailing Address - Country:US
Mailing Address - Phone:907-561-8573
Mailing Address - Fax:907-563-6094
Practice Address - Street 1:3401 DENALI ST
Practice Address - Street 2:STE 201
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4034
Practice Address - Country:US
Practice Address - Phone:907-561-8573
Practice Address - Fax:907-563-6094
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice