=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518841998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL REZICH D.D.S. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 BETZ RD
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68005-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-291-3721
-----------------------------------------------------
Fax | 402-291-7566
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 BETZ RD
-----------------------------------------------------
City | BELLEVUE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68005-3059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-291-3721
-----------------------------------------------------
Fax | 402-291-7566
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | DR. MICHAEL TOBIN REZICH
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 402-291-3721
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------