Organization
COLUMBUS GROVE FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EARL RECKER (OWNER)
(419) 659-6000
Entity
Organization
Contact information
Practice address
109 N HIGH ST, COLUMBUS GROVE, OH 45830-1240
(419) 659-6000
(419) 659-6004
Mailing address
109 N HIGH ST, COLUMBUS GROVE, OH 45830-1240
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30-02-0534
OH
Other
Enumeration date
04/02/2008
Last updated
04/02/2008
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