Healthcare Provider Details

I. General information

NPI: 1093646317
Provider Name (Legal Business Name): REZNIK DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MARKET ST STE 209
GAITHERSBURG MD
20878-6559
US

IV. Provider business mailing address

60 MARKET ST STE 209
GAITHERSBURG MD
20878-6559
US

V. Phone/Fax

Practice location:
  • Phone: 240-631-9363
  • Fax: 240-931-9363
Mailing address:
  • Phone: 240-631-9363
  • Fax: 240-931-9363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. REZA NIKOOKAR
Title or Position: OWNER
Credential: NIKOOKAR
Phone: 858-999-6686