Active NPI
Shirley Konstance Locke, D.D.S.
- General Practice Dentistry
- Lake Tapps, WA
National Provider Identifier
1053604041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DE 6049
- Practice address
- 4429 185TH Ave E
Lake Tapps, WA 98391-9112 - Phone
- (253) 862-1435
- NPI assigned
- May 24, 2011
- Last updated
- May 24, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DE 6049 | WA | Primary |
Addresses
Primary practice location
4429 185TH Ave E
Lake Tapps, WA 98391-9112
Mailing address
4429 185TH Ave E
Lake Tapps, WA 98391-9112
Phone (253) 862-1435
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE 6049 | WA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1306195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1306195200000",
"number": "1053604041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4429 185TH AVE E",
"city": "LAKE TAPPS",
"state": "WA",
"postal_code": "983919112",
"telephone_number": "253-862-1435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4429 185TH AVE E",
"city": "LAKE TAPPS",
"state": "WA",
"postal_code": "983919112",
"telephone_number": "253-862-1435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOCKE",
"first_name": "SHIRLEY",
"middle_name": "KONSTANCE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-24",
"last_updated": "2011-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WA",
"license": "DE 6049",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Tapps, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.