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General NPI Number Information
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NPI Number | 1477921674
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Entity Type | Organization
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Legal Business Name | MECKLER DENTAL PROVIDERS (WILLOUGHBY), INC.
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 03/20/2018
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Provider Practice Location Address
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Address Line | 36173 EUCLID AVE
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City | WILLOUGHBY
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State | OH
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Zip | 44094-4410
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Country | US
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Telephone | 440-946-0640
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Fax | 216-584-1085
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Provider Business Mailing Address
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Address Line | 7160 DALLAS PKWY STE 400
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City | PLANO
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State | TX
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Zip | 75024-7111
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER CREDENTIALING
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Name | RACHEL NITTINGER
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Credential |
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Telephone | 972-755-0816
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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