Provider Demographics
NPI:1780727651
Name:RECK, MATTHEW RAYMOND (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:RAYMOND
Last Name:RECK
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 1:12890 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIBR19543551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice