Provider Demographics
NPI:1700974615
Name:MARK J. MECKES, DDS, INC.
Entity Type:Organization
Organization Name:MARK J. MECKES, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MECKES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-438-9994
Mailing Address - Street 1:5580 E 2ND ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-3946
Mailing Address - Country:US
Mailing Address - Phone:562-438-9994
Mailing Address - Fax:
Practice Address - Street 1:5580 E 2ND ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-3946
Practice Address - Country:US
Practice Address - Phone:562-438-9994
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43371122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty