| C. Michael Locke, D.m.d.,m.d.,plc | |
|
105 Ledford Mill Rd Ste A Tullahoma TN 37388-8262 | |
| (931) 455-2105 | |
| (931) 455-2104 |
| Full Name | C. Michael Locke, D.m.d.,m.d.,plc |
|---|---|
| Speciality | Dentist |
| Location | 105 Ledford Mill Rd Ste A, Tullahoma, Tennessee |
| Authorized Official Name and Position | C. Michael Locke (OWNER) |
| Authorized Official Contact | 9314552105 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C. Michael Locke, D.m.d.,m.d.,plc 125 Ledford Mill Rd Tullahoma TN 37388-2278 Ph: (931) 455-2105 | C. Michael Locke, D.m.d.,m.d.,plc 105 Ledford Mill Rd Ste A Tullahoma TN 37388-8262 Ph: (931) 455-2105 |
| NPI Number | 1811169071 |
|---|---|
| Provider Enumeration Date | 03/27/2008 |
| Last Update Date | 12/02/2022 |
| Medicare PECOS PAC ID | 3678712965 |
|---|---|
| Medicare Enrollment ID | O20130618000201 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811169071 | NPI | - | NPPES |
| 4013636 | Other | TN | BLUE CROSS BLUE SHIELD |
| 79318 | Other | TN | UPIN |
| 338420 | Other | TN | UNITED CONCORDIA |
| 3208948 | Medicaid | TN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | DS0000007685 (Tennessee) | Primary |
| Provider Name | Charles Michael Locke |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1184721995 PECOS PAC ID: 3678486388 Enrollment ID: I20031110000172 |
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