Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2246 | WV |
N | 1223D0001X | Dental Public Health | 2246 | WV |
NPI | 1457773723 |
---|---|
Provider Name | Dr. Richard Lee Meckstroth |
First Address | Morgantown, WV 26506-9415 |
Second Address | Morgantown, WV 26506-9415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2014 |
Last Update Date | 06/01/2014 |