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General NPI Number Information
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NPI Number | 1295293553
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Entity Type | Organization
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Legal Business Name | GARY REZNIK D.D.S., P.A.
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 1816 EMMORTON RD
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City | BEL AIR
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State | MD
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Zip | 21015
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Country | US
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Telephone | 410-879-9111
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Fax | 443-512-8888
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Provider Business Mailing Address
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Address Line | 1816 EMMORTON RD
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City | BEL AIR
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State | MD
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Zip | 21015
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Country | US
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Telephone | 410-879-9111
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Fax | 443-512-8888
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Authorized Official
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Title or Position | DENTIST - OWNER
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Name | DR. GARY REZNIK
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Credential | DDS
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Telephone | 410-879-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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