Provider Demographics
NPI:1437547486
Name:ROBERT V. REZNICHEK DDS, A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:ROBERT V. REZNICHEK DDS, A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST-ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:REZNICHEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-745-1831
Mailing Address - Street 1:135 E THIRD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92595-4252
Mailing Address - Country:US
Mailing Address - Phone:760-745-1831
Mailing Address - Fax:760-745-3415
Practice Address - Street 1:135 E THIRD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92595-4252
Practice Address - Country:US
Practice Address - Phone:760-745-1831
Practice Address - Fax:760-745-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-29
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty