Organization
REZNIKOV DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEXANDER REZNIKOV DDS (OWNER/DENTIST)
(847) 877-3570
Entity
Organization
Contact information
Practice address
1556 S MICHIGAN AVE, STE 110, CHICAGO, IL 60605-1937
(312) 588-0043
(312) 588-0287
Mailing address
1556 S MICHIGAN AVE, STE 110, CHICAGO, IL 60605
(312) 588-0043
(312) 588-0287
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019029473
IL
1223P0300X
Periodontics
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
05/11/2015
Last updated
05/11/2015
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