Provider Demographics
NPI:1326591512
Name:RECK, CARA (RDH, BS)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:RECK
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9736
Mailing Address - Country:US
Mailing Address - Phone:406-539-0894
Mailing Address - Fax:
Practice Address - Street 1:37 JEFFERSON DR
Practice Address - Street 2:
Practice Address - City:CLANCY
Practice Address - State:MT
Practice Address - Zip Code:59634-9736
Practice Address - Country:US
Practice Address - Phone:406-539-0894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4172124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist