Healthcare Provider Details

I. General information

NPI: 1912907700
Provider Name (Legal Business Name): EARL JOSEPH RECKER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 N HIGH ST
COLUMBUS GROVE OH
45830-1240
US

IV. Provider business mailing address

109 N HIGH ST
COLUMBUS GROVE OH
45830-1240
US

V. Phone/Fax

Practice location:
  • Phone: 419-659-6000
  • Fax: 419-659-6004
Mailing address:
  • Phone: 419-659-6000
  • Fax: 419-659-6004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-02-0534
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: