MEDICARE: DR. LINDSEY A REZNIK D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19494	FL

General Provider Information

NPI Number	:	1164710976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSEY A REZNIK D.M.D.

Provider Business Mailing Address
First Line	:	815 NW FLAGLER AVE
Second Line	:	#305
City	:	STUART
State	:	FL
Zip	:	34994-1158
Country	:	US
Telephone Number	:	813-417-0028
Fax Number	:

Provider Business Practice Location Address
First Line	:	7554 S US HIGHWAY 1
Second Line	:	SUITE 13
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-1450
Country	:	US
Telephone Number	:	772-343-1762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/19/2012

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