Active NPI
Reza Nikookar
- Dentist
- Glenn Dale, MD
National Provider Identifier
1013783166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 18347
- Practice address
- 12150 Annapolis Rd Ste 301
Glenn Dale, MD 20769-9183 - Phone
- (773) 875-0554
- NPI assigned
- Nov 29, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 18347 | MD | Primary |
| General Practice Dentistry | 1223G0001X | 18347 | MD |
Addresses
Primary practice location
12150 Annapolis Rd Ste 301
Glenn Dale, MD 20769-9183
Mailing address
PO Box 7065
Gaithersburg, MD 20898-7065
Phone (185) 899-9668
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18347 | MD | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reznik Dental LLC | Dentist | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Gaithersburg, MD
- NPI 1093646317
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1701216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701216000000",
"number": "1013783166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7065",
"city": "GAITHERSBURG",
"state": "MD",
"postal_code": "208987065",
"telephone_number": "185-899-9668"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12150 ANNAPOLIS RD STE 301",
"city": "GLENN DALE",
"state": "MD",
"postal_code": "207699183",
"telephone_number": "773-875-0554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NIKOOKAR",
"first_name": "REZA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-11-29",
"last_updated": "2023-11-29",
"certification_date": "2023-11-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MD",
"license": "18347",
"primary": true
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MD",
"license": "18347",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glenn Dale, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.