Provider Demographics
NPI:1457350845
Name:STICKRATH, ROBERT B (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:STICKRATH
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 1:126 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-3108
Mailing Address - Country:US
Mailing Address - Phone:740-374-8867
Mailing Address - Fax:740-374-2817
Practice Address - Street 1:126 3RD ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-3108
Practice Address - Country:US
Practice Address - Phone:740-374-8867
Practice Address - Fax:740-374-2817
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice