Provider Demographics
NPI:1861693491
Name:RECKER, BRYAN MARK (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:MARK
Last Name:RECKER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 VIKING DR NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-3522
Mailing Address - Country:US
Mailing Address - Phone:507-208-9124
Mailing Address - Fax:507-218-0326
Practice Address - Street 1:2112 VIKING DR NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-3522
Practice Address - Country:US
Practice Address - Phone:507-208-9124
Practice Address - Fax:507-218-0326
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND127331223P0300X
IA084161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics