Provider Demographics
NPI:1164710976
Name:REZNIK, LINDSEY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:LINDSEY
Middle Name:A
Last Name:REZNIK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 NW FLAGLER AVE
Mailing Address - Street 2:#305
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-1158
Mailing Address - Country:US
Mailing Address - Phone:813-417-0028
Mailing Address - Fax:
Practice Address - Street 1:7554 S US HIGHWAY 1
Practice Address - Street 2:SUITE 13
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-1450
Practice Address - Country:US
Practice Address - Phone:772-343-1762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19494122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist