Organization
LEGACY PEDO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL REZNIK DDS (OWNER)
(770) 777-7427
Entity
Organization
Contact information
Practice address
3903 JILES RD NW, #210, KENNESAW, GA 30144-4612
(770) 590-9050
Mailing address
3903 JILES RD NW, #210, KENNESAW, GA 30144-4612
(770) 590-9050
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
06/08/2010
Last updated
06/08/2010
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