Provider Demographics
NPI:1114170479
Name:REZNIK, MEGAN NICOLE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:NICOLE
Last Name:REZNIK
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:MEGAN
Other - Middle Name:NICOLE
Other - Last Name:WEISKIRCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:2469 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4232
Mailing Address - Country:US
Mailing Address - Phone:432-333-7105
Mailing Address - Fax:
Practice Address - Street 1:2469 E 11TH ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4232
Practice Address - Country:US
Practice Address - Phone:432-333-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX234231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics