Provider Demographics
NPI:1497745459
Name:MECKLER, GARY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:MECKLER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 CARMEL AVE NE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3147
Mailing Address - Country:US
Mailing Address - Phone:505-878-0700
Mailing Address - Fax:505-880-1020
Practice Address - Street 1:8300 CARMEL AVE NE
Practice Address - Street 2:SUITE 602
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-3147
Practice Address - Country:US
Practice Address - Phone:505-878-0700
Practice Address - Fax:505-880-1020
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD19931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB8319Medicaid