Provider Demographics
NPI:1407148216
Name:RECKSIEDLER, SCOTT (DMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:RECKSIEDLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8860 CENTER DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3068
Mailing Address - Country:US
Mailing Address - Phone:619-463-3773
Mailing Address - Fax:619-463-1272
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:SUITE 460
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3068
Practice Address - Country:US
Practice Address - Phone:619-463-3773
Practice Address - Fax:619-463-1272
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA607471223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics