Healthcare Provider Details

I. General information

NPI: 1679670954
Provider Name (Legal Business Name): JEFFREY MECKLER, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CASS STREET SUITE 100
MONTEREY CA
93940
US

IV. Provider business mailing address

920 CASS STREET SUITE 100
MONTEREY CA
93940
US

V. Phone/Fax

Practice location:
  • Phone: 831-373-1377
  • Fax: 831-372-0463
Mailing address:
  • Phone: 831-373-1377
  • Fax: 831-372-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number38951
License Number StateCA

VIII. Authorized Official

Name: DR. JEFFREY MECKLER
Title or Position: OWNER
Credential: D.D.S.
Phone: 831-373-1377