Provider Demographics
NPI:1750464079
Name:RECK, DIANE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:ELIZABETH
Last Name:RECK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:ELIZABETH
Other - Last Name:KOPRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7560 RANGEWOOD DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920
Mailing Address - Country:US
Mailing Address - Phone:719-266-4848
Mailing Address - Fax:719-266-8055
Practice Address - Street 1:7560 RANGEWOOD DR
Practice Address - Street 2:SUITE 220
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-266-4848
Practice Address - Fax:719-266-8055
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8188122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist