Provider Demographics
NPI:1245373349
Name:DR. DIANNE WHITFIELD-LOCKE
Entity type:Organization
Organization Name:DR. DIANNE WHITFIELD-LOCKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITIFIELD-LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-420-1464
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. DIANNE WHITIFIELD-LOCKE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-15
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD92291223E0200X
DC45181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1417063363OtherINDIVIDUAL NPI
DC016747900Medicaid