Healthcare Provider Details

I. General information

NPI: 1508628751
Provider Name (Legal Business Name): RECKLING DDS, PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2024
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 N SYCAMORE AVE
SIOUX FALLS SD
57110-5737
US

IV. Provider business mailing address

518 N SYCAMORE AVE
SIOUX FALLS SD
57110-5737
US

V. Phone/Fax

Practice location:
  • Phone: 605-373-0245
  • Fax: 605-336-3261
Mailing address:
  • Phone: 605-373-0245
  • Fax: 605-336-3261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. RYON ROBERT RECKLING
Title or Position: OWNER, DENTIST
Credential: DDS
Phone: 605-373-0245