Provider Demographics
NPI:1346447307
Name:REZNIK, LEONID (DDS)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:REZNIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 BELLMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710
Mailing Address - Country:US
Mailing Address - Phone:516-826-6827
Mailing Address - Fax:
Practice Address - Street 1:1595 STRAIGHT PATH
Practice Address - Street 2:
Practice Address - City:WYANDANCH
Practice Address - State:NY
Practice Address - Zip Code:11798-2407
Practice Address - Country:US
Practice Address - Phone:631-643-3800
Practice Address - Fax:631-253-4292
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0492601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice