Healthcare Provider Details

I. General information

NPI: 1295293553
Provider Name (Legal Business Name): GARY REZNIK D.D.S., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 EMMORTON RD
BEL AIR MD
21015
US

IV. Provider business mailing address

1816 EMMORTON RD
BEL AIR MD
21015
US

V. Phone/Fax

Practice location:
  • Phone: 410-879-9111
  • Fax: 443-512-8888
Mailing address:
  • Phone: 410-879-9111
  • Fax: 443-512-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY REZNIK
Title or Position: DENTIST - OWNER
Credential: DDS
Phone: 410-879-9111