Provider Demographics
NPI:1114060761
Name:MCTAGGART, ROBERT T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:MCTAGGART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 ROUTE 37 E
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-5521
Mailing Address - Country:US
Mailing Address - Phone:732-341-9111
Mailing Address - Fax:732-341-0772
Practice Address - Street 1:224 ROUTE 37 E
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-5521
Practice Address - Country:US
Practice Address - Phone:732-341-9111
Practice Address - Fax:732-341-0772
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ204171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8427607Medicaid