Provider Demographics
NPI:1528626579
Name:LOCKLEAR, DARRYL II (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:
Last Name:LOCKLEAR
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SHORE LAKE DR APT K
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1471
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:336-282-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice