MEDICARE: DR. AURORE REZK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN14777	FL

General Provider Information

NPI Number	:	1174666481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AURORE REZK D.M.D.

Provider Business Mailing Address
First Line	:	900 VIRGINIA AVE
Second Line	:	SUITE # 4
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5882
Country	:	US
Telephone Number	:	772-461-4330
Fax Number	:	772-461-9518

Provider Business Practice Location Address
First Line	:	900 VIRGINIA AVE
Second Line	:	SUITE # 4
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5882
Country	:	US
Telephone Number	:	772-461-4330
Fax Number	:	772-461-9518

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/08/2007

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