Provider Demographics
NPI:1659887669
Name:MATTHEW R. RECK
Entity Type:Organization
Organization Name:MATTHEW R. RECK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-426-4455
Mailing Address - Street 1:12890 RED ARROW HWY
Mailing Address - Street 2:
Mailing Address - City:SAWYER
Mailing Address - State:MI
Mailing Address - Zip Code:49125-9173
Mailing Address - Country:US
Mailing Address - Phone:269-426-4455
Mailing Address - Fax:269-426-3017
Practice Address - Street 1:12890 RED ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAWYER
Practice Address - State:MI
Practice Address - Zip Code:49125-9173
Practice Address - Country:US
Practice Address - Phone:269-426-4455
Practice Address - Fax:269-426-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty