MEDICARE: DR. ROBERT W. RECHTIEN JR. D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DEN015300	MO

General Provider Information

NPI Number	:	1740326966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W. RECHTIEN JR. D.D.S.

Provider Business Mailing Address
First Line	:	6712 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-3345
Country	:	US
Telephone Number	:	816-436-1785
Fax Number	:	816-436-2811

Provider Business Practice Location Address
First Line	:	6712 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-3345
Country	:	US
Telephone Number	:	816-436-1785
Fax Number	:	816-436-2811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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