Provider Demographics
NPI:1386704849
Name:REZNICK, PAUL (CD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:REZNICK
Suffix:
Gender:M
Credentials:CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 LORELLA AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-7823
Mailing Address - Country:US
Mailing Address - Phone:541-343-1022
Mailing Address - Fax:
Practice Address - Street 1:2703 DELTA OAKS DR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-1700
Practice Address - Country:US
Practice Address - Phone:541-342-4292
Practice Address - Fax:541-345-3970
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDTD038007122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist