Provider Demographics
NPI:1871607994
Name:RECHTIN, THEODORE ANTHONY III (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ANTHONY
Last Name:RECHTIN
Suffix:III
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 1:3450 BRIDGELAND DR STE A
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2605
Mailing Address - Country:US
Mailing Address - Phone:314-770-0400
Mailing Address - Fax:314-770-0170
Practice Address - Street 1:3450 BRIDGELAND DR
Practice Address - Street 2:SUITE A
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2605
Practice Address - Country:US
Practice Address - Phone:314-770-0400
Practice Address - Fax:314-770-0170
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000157414332B00000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies