Individual
MARINA REZKALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(224) 535-0855
Mailing address
400 S TOWNLINE RD, WAUTOMA, WI 54982-6922
(224) 535-0855
Taxonomy
Speciality
Code
Description
License number
State
1041S0200X
School Social Worker
—
—
1223G0001X
General Practice Dentistry
Primary
6001829-15
WI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/10/2023
Last updated
06/02/2025
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