Healthcare Provider Details

I. General information

NPI: 1174666481
Provider Name (Legal Business Name): AURORE REZK D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 VIRGINIA AVE SUITE # 4
FORT PIERCE FL
34982-5882
US

IV. Provider business mailing address

900 VIRGINIA AVE SUITE # 4
FORT PIERCE FL
34982-5882
US

V. Phone/Fax

Practice location:
  • Phone: 772-461-4330
  • Fax: 772-461-9518
Mailing address:
  • Phone: 772-461-4330
  • Fax: 772-461-9518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN14777
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: