MEDICARE: MECKLER DENTAL PROVIDERS (WESTGATE), INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223G0001X	General Practice Dentistry
3	1223P0221X	Pediatric Dentistry
4	1223P0300X	Periodontics
5	1223P0700X	Prosthodontics
6	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
7	122300000X	Dentist

General Provider Information

NPI Number	:	1184694556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MECKLER DENTAL PROVIDERS (WESTGATE), INC.

Provider Business Mailing Address
First Line	:	7160 NORTH DALLAS PARKWAY ST 400
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	55486-7145
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3504 SECOR RD ST. 330
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43606-1544
Country	:	US
Telephone Number	:	419-534-3005
Fax Number	:

Authorized Official
Title or Position	:	MANAGER, CREDENTIALING
Name	:	RACHEL NITTINGER
Credential	:
Telephone Number	:	972-755-0816

Provider Enumeration Date	:	01/26/2006
Last Update Date	:	03/17/2018

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