MEDICARE: DR. JAY BRIAN REZNICK MD, DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	37485	CA
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	123680	GA
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	A055148	CA
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	103907	GA

General Provider Information

NPI Number	:	1962519272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY BRIAN REZNICK MD, DMD

Provider Business Mailing Address
First Line	:	2060 KNIGHTSBRIDGE WAY
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30004-6732
Country	:	US
Telephone Number	:	818-269-5625
Fax Number	:	818-269-5625

Provider Business Practice Location Address
First Line	:	8265 HIGHWAY 92 STE 116
Second Line	:
City	:	WOODSTOCK
State	:	GA
Zip	:	30189-6520
Country	:	US
Telephone Number	:	818-269-5625
Fax Number	:

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

Provider Enumeration Date	:	08/23/2006
Last Update Date	:	01/13/2026

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