Healthcare Provider Details

I. General information

NPI: 1962410423
Provider Name (Legal Business Name): JOHN RICHARD RECH D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST SUITE 403
BERKELEY CA
94705-2146
US

IV. Provider business mailing address

2999 REGENT ST SUITE 403
BERKELEY CA
94705-2146
US

V. Phone/Fax

Practice location:
  • Phone: 150-084-3634
  • Fax:
Mailing address:
  • Phone: 150-084-3634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number26279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: