Provider Demographics
NPI:1770677361
Name:MCALLISTER, EDWARD LOCKE I (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LOCKE
Last Name:MCALLISTER
Suffix:I
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 1:1530S. RANGELINE RD
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3229
Mailing Address - Country:US
Mailing Address - Phone:417-623-1414
Mailing Address - Fax:417-624-2582
Practice Address - Street 1:1530 S. RANGELINE RD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3229
Practice Address - Country:US
Practice Address - Phone:417-623-1414
Practice Address - Fax:417-624-2582
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO147321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice