Provider Demographics
NPI:1336157338
Name:LOCKE WHITE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:LOCKE WHITE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOCKE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-925-5100
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:529 NANTASKET AVE
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045
Mailing Address - Country:US
Mailing Address - Phone:781-925-5100
Mailing Address - Fax:781-925-9791
Practice Address - Street 1:529 NANTASKET AVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045
Practice Address - Country:US
Practice Address - Phone:781-925-5100
Practice Address - Fax:781-925-9791
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA164401223G0001X
MA207691223G0001X
MA98961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9779841Medicaid