Healthcare Provider Details

I. General information

NPI: 1861513335
Provider Name (Legal Business Name): GARY REZNIK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 EMMORTON RD SUITE 201
BEL AIR MD
21015-6179
US

IV. Provider business mailing address

2015 EMMORTON RD SUITE 201
BEL AIR MD
21015-6179
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 TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12813
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: