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General NPI Number Information
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NPI Number | 1962519272
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Entity Type | Individual
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Provider Name | JAY BRIAN REZNICK MD, DMD
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 01/13/2026
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Provider Practice Location Address
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Address Line | 8265 HIGHWAY 92 STE 116
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City | WOODSTOCK
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State | GA
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Zip | 30189-6520
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Country | US
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Telephone | 818-269-5625
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Fax |
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Provider Business Mailing Address
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Address Line | 2060 KNIGHTSBRIDGE WAY
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City | ALPHARETTA
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State | GA
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Zip | 30004-6732
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Country | US
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Telephone | 818-269-5625
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Fax | 818-269-5625
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 37485
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 123680
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | A055148
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 103907
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License Number State | GA
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