Provider Demographics
NPI:1437756905
Name:EAST RIDGE DENTAL LLC
Entity Type:Organization
Organization Name:EAST RIDGE DENTAL LLC
Other - Org Name:EAST RIDGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYON
Authorized Official - Middle Name:
Authorized Official - Last Name:RECKLING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-373-0245
Mailing Address - Street 1:518 N SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-5737
Mailing Address - Country:US
Mailing Address - Phone:605-373-0245
Mailing Address - Fax:
Practice Address - Street 1:518 N SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-5737
Practice Address - Country:US
Practice Address - Phone:605-373-0245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental