Provider Demographics
NPI:1194739086
Name:MEDDAUGH, ROBERT WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:MEDDAUGH
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 1:2075 S 81ST ST
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53219-1013
Mailing Address - Country:US
Mailing Address - Phone:414-327-6160
Mailing Address - Fax:414-327-6088
Practice Address - Street 1:2075 S 81ST ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53219-1013
Practice Address - Country:US
Practice Address - Phone:414-327-6160
Practice Address - Fax:414-327-6088
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice