Provider Demographics
NPI:1700514551
Name:DARRYL LOCKLEAR II DDS PA
Entity type:Organization
Organization Name:DARRYL LOCKLEAR II DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DARRYL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-734-0871
Mailing Address - Street 1:2803 REGENTS PARK LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2203
Mailing Address - Country:US
Mailing Address - Phone:910-734-0871
Mailing Address - Fax:
Practice Address - Street 1:2707 PINEDALE RD STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2020
Practice Address - Country:US
Practice Address - Phone:910-734-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental