Provider Demographics
NPI:1497843429
Name:MCGRATH, ROBERT E (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:MCGRATH
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:PO BOX 1178
Mailing Address - Street 2:1730 7TH STREET SO
Mailing Address - City:WISCONSIN RAPIDS
Mailing Address - State:WI
Mailing Address - Zip Code:54495
Mailing Address - Country:US
Mailing Address - Phone:715-423-3322
Mailing Address - Fax:715-424-3786
Practice Address - Street 1:1730 7TH STREET SO
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54495
Practice Address - Country:US
Practice Address - Phone:715-423-3322
Practice Address - Fax:715-424-3786
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5001043015122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist