MEDICARE: PAUL M. REZICH, DDS, PC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1336209808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAUL M. REZICH, DDS, PC

Provider Business Mailing Address
First Line	:	503 E NORTH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-1462
Country	:	US
Telephone Number	:	605-343-2229
Fax Number	:	605-343-7516

Provider Business Practice Location Address
First Line	:	503 E NORTH ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-1462
Country	:	US
Telephone Number	:	605-343-2229
Fax Number	:	605-343-7516

Authorized Official
Title or Position	:	OWNER PRESIDENT
Name	:	DR. PAUL M REZICH
Credential	:	DDS
Telephone Number	:	605-343-2229

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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