Bryan Mark Recker, D.D.S., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D12733 Issued in MN

Practice address

2112 Viking Dr NW
Rochester, MN 55901-3522

Phone

(507) 208-9124

Fax

(507) 218-0326

NPI assigned

May 30, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Feb 16, 2016 through Feb 16, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435104000000",
    "number": "1861693491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 VIKING DR NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013522",
            "telephone_number": "507-208-9124",
            "fax_number": "507-218-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 VIKING DR NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559013522",
            "telephone_number": "507-208-9124",
            "fax_number": "507-218-0326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RECKER",
        "first_name": "BRYAN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2015-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "MN",
            "license": "D12733",
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IA",
            "license": "08416",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Andrea Rebolledo, MD
• Rebound Health Service LLC
• Karen L Rech, M.D.
• Julian Simon Rechberger, MD, PHD
• Jade Suzanne Rechtzigel
• Chelsey A Recker, PA
• James Dean Recker
• Jensen Reckhow, MD
• Mandy Marie Reckward
• Matthew James Record

• Periodontics in Rochester, MN
• Providers in Rochester, MN by specialty
• Periodontics in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.