Provider Demographics
NPI:1013937424
Name:RECKIS, ROGER GROVER (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GROVER
Last Name:RECKIS
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 1:568 PARKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-9275
Mailing Address - Country:US
Mailing Address - Phone:802-885-3636
Mailing Address - Fax:
Practice Address - Street 1:5 HENRY ST
Practice Address - Street 2:
Practice Address - City:BELLOWS FALLS
Practice Address - State:VT
Practice Address - Zip Code:05101-1509
Practice Address - Country:US
Practice Address - Phone:802-463-4695
Practice Address - Fax:802-463-9437
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT826122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist