Provider Demographics
NPI:1326569377
Name:RECHTIN, PAIGE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:RECHTIN
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N 2ND ST APT 216
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55401-5345
Mailing Address - Country:US
Mailing Address - Phone:419-509-8760
Mailing Address - Fax:
Practice Address - Street 1:4845 RIALTO RD STE A
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-2910
Practice Address - Country:US
Practice Address - Phone:513-772-6500
Practice Address - Fax:513-772-2002
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY103271223X0400X
OH30.0258781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1003575586Medicaid