Provider Demographics
NPI:1326068024
Name:MACKIE, ROBERT M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:MACKIE
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 1:18672 FLORIDA ST
Mailing Address - Street 2:#301
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1925
Mailing Address - Country:US
Mailing Address - Phone:714-596-2177
Mailing Address - Fax:
Practice Address - Street 1:18672 FLORIDA ST
Practice Address - Street 2:#301
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1925
Practice Address - Country:US
Practice Address - Phone:714-596-2177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA371351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice