Provider Demographics
NPI:1902217490
Name:REZK, MOHAMED A (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:A
Last Name:REZK
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N BERKSHIRE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-2761
Mailing Address - Country:US
Mailing Address - Phone:434-528-8885
Mailing Address - Fax:
Practice Address - Street 1:2202 N BERKSHIRE RD STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-2761
Practice Address - Country:US
Practice Address - Phone:434-528-8885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014156271223P0300X
KY9415122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist