Provider Demographics
NPI:1144353921
Name:RECKER, DOUGLAS A (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:RECKER
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 1:11440 HAMILTON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45231-6103
Mailing Address - Country:US
Mailing Address - Phone:513-742-4200
Mailing Address - Fax:513-742-4841
Practice Address - Street 1:11440 HAMILTON AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45231-6103
Practice Address - Country:US
Practice Address - Phone:513-742-4200
Practice Address - Fax:513-742-4841
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH212281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice