Provider Demographics
NPI:1619190246
Name:MCCARTHA, ROBERT P (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:MCCARTHA
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 1:2039 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:SC
Mailing Address - Zip Code:29108-2249
Mailing Address - Country:US
Mailing Address - Phone:803-276-3371
Mailing Address - Fax:
Practice Address - Street 1:2039 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-2249
Practice Address - Country:US
Practice Address - Phone:803-276-3371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice