Provider Demographics
NPI:1770623969
Name:MECKSTROTH, ROBERT K (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:MECKSTROTH
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 1:628 PROGRESS ST STE E
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48661-9383
Mailing Address - Country:US
Mailing Address - Phone:866-878-6558
Mailing Address - Fax:
Practice Address - Street 1:70 STONY POINT RD. ST.E
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4460
Practice Address - Country:US
Practice Address - Phone:707-575-9200
Practice Address - Fax:707-575-4546
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD1036395122300000X
CA36395122300000X
MI29010221151223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist