Provider Demographics
NPI:1578003794
Name:BRAD RECK
Entity Type:Organization
Organization Name:BRAD RECK
Other - Org Name:HEART OF THE THUMB DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:FREIBURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-635-7411
Mailing Address - Street 1:2621 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARLETTE
Mailing Address - State:MI
Mailing Address - Zip Code:48453-1143
Mailing Address - Country:US
Mailing Address - Phone:989-635-7411
Mailing Address - Fax:989-635-7413
Practice Address - Street 1:2621 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARLETTE
Practice Address - State:MI
Practice Address - Zip Code:48453-1143
Practice Address - Country:US
Practice Address - Phone:989-635-7411
Practice Address - Fax:989-635-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI21378122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty