Healthcare Provider Details

I. General information

NPI: 1043324593
Provider Name (Legal Business Name): HE & TA RECHTIN DDS,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 11/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 BRIDGELAND DR SUITE A
BRIDGETON MO
63044-2605
US

IV. Provider business mailing address

3450 BRIDGELAND DR STE A
BRIDGETON MO
63044-2605
US

V. Phone/Fax

Practice location:
  • Phone: 314-770-0400
  • Fax: 314-770-0170
Mailing address:
  • Phone: 314-770-0400
  • Fax: 314-770-0170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2000157414
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: THEODORE ANTHONY RECHTIN III
Title or Position: OWNER
Credential:
Phone: 314-770-0400