Provider Demographics
NPI:1609044106
Name:CHERYL R. LOCKLEAR, DDS
Entity Type:Organization
Organization Name:CHERYL R. LOCKLEAR, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:R
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-843-4262
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:28377-0231
Practice Address - Country:US
Practice Address - Phone:910-843-4262
Practice Address - Fax:910-843-1238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4659261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC805789OtherUNITED CONCORDIA
NC805789OtherTRICARE
NC8995366Medicaid
NC95366OtherNC HEALTH CHOICE
NC95366OtherBLUECROSS BLUESHIELD