Healthcare Provider Details

I. General information

NPI: 1306803093
Provider Name (Legal Business Name): ASTRID A RECIO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/30/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHAFFEE RD 4323 HILL STREET
COLUMBIA SC
29207
US

IV. Provider business mailing address

4323 HILL ST
COLUMBIA SC
29207-6022
US

V. Phone/Fax

Practice location:
  • Phone: 915-244-3996
  • Fax:
Mailing address:
  • Phone: 803-751-6213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2400
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2400
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: