Provider Demographics
NPI:1336590165
Name:RECTOR, MARY WIECHART (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:WIECHART
Last Name:RECTOR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:WIECHART
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:409 E KIRACOFE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45807-1031
Mailing Address - Country:US
Mailing Address - Phone:419-331-0031
Mailing Address - Fax:
Practice Address - Street 1:409 E KIRACOFE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-1031
Practice Address - Country:US
Practice Address - Phone:419-331-0031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH247731223G0001X
OH30.0247731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice