Healthcare Provider Details

I. General information

NPI: 1437086394
Provider Name (Legal Business Name): BUCKTOWN DENTAL REZ, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 W ARMITAGE AVE
CHICAGO IL
60647-4461
US

IV. Provider business mailing address

2232 W ARMITAGE AVE
CHICAGO IL
60647-4461
US

V. Phone/Fax

Practice location:
  • Phone: 773-278-0600
  • Fax:
Mailing address:
  • Phone: 773-278-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER REZNIKOV
Title or Position: PRESIDENT
Credential: DDS
Phone: 847-877-3570