Provider Demographics
NPI:1508628751
Name:RECKLING DDS, PROF LLC
Entity Type:Organization
Organization Name:RECKLING DDS, PROF LLC
Other - Org Name:EAST RIDGE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYON
Authorized Official - Middle Name:ROBERT
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:605-336-3261
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:605-336-3261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1073860128OtherINDIVIDUAL NPI
SD1407235229OtherINDIVIDUAL NPI
SD1437756905OtherCORPORATION
SD1841362266OtherINDIVIDUAL NPI