Healthcare Provider Details

I. General information

NPI: 1275678559
Provider Name (Legal Business Name): KENNETH M. HRECHKA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6130 OXON HILL RD SUITE 304
OXON HILL MD
20745-3103
US

IV. Provider business mailing address

6130 OXON HILL RD SUITE 304
OXON HILL MD
20745-3103
US

V. Phone/Fax

Practice location:
  • Phone: 301-839-2500
  • Fax:
Mailing address:
  • Phone: 301-839-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number6952
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: