Provider Demographics
NPI:1811053291
Name:MCKINSTRY, ROBERT E (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MCKINSTRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5547 BEVERLY PL
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-1426
Mailing Address - Country:US
Mailing Address - Phone:412-661-2963
Mailing Address - Fax:412-361-3767
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2407
Practice Address - Country:US
Practice Address - Phone:724-837-3911
Practice Address - Fax:724-837-7511
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021038L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001575219Medicaid