Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 2136 | TN |
NPI | 1144313677 |
---|---|
Provider Name | Dr. Benjamin Franklin Locke JR. |
First Address | Brentwood, TN 37027 |
Second Address | Nashville, TN 37203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |