Provider Demographics
NPI:1376388264
Name:COUNCE, MARENA LOCKE (DDS)
Entity type:Individual
Prefix:DR
First Name:MARENA
Middle Name:LOCKE
Last Name:COUNCE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S GREER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-3212
Mailing Address - Country:US
Mailing Address - Phone:901-258-2793
Mailing Address - Fax:
Practice Address - Street 1:560 COLONIAL RD STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4033
Practice Address - Country:US
Practice Address - Phone:901-680-6881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN125271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice