Provider Demographics
NPI:1518905553
Name:RECKNAGEL, CHRIS ANDREW (DDS)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:ANDREW
Last Name:RECKNAGEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N MUSTANG RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5168
Mailing Address - Country:US
Mailing Address - Phone:405-324-0024
Mailing Address - Fax:405-324-0037
Practice Address - Street 1:801 N MUSTANG RD
Practice Address - Street 2:SUITE A
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5168
Practice Address - Country:US
Practice Address - Phone:405-324-0024
Practice Address - Fax:405-324-0037
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-03
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731613618OtherTIN