Larisa Reznik, LDD
Individual provider Active NPI Denturist · Anderson Island, WA
NPI 1386839736 · NPPES record last updated Sep 10, 2007
Key facts
- NPI
- 1386839736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Denturist 122400000X
- License
- DN00000325 (WA)
- Practice address
- 11414 Matthews Way
Anderson Island, WA 98303 - Phone
- (253) 884-2369
- NPI assigned
- Sep 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN00000325 | WA | MD | Denturist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Denturist | 122400000X | DN00000325 | WA | Yes |
Addresses
Primary practice location
11414 Matthews Way
Anderson Island, WA 98303
Mailing address
11414 Matthews Way
Anderson Island, WA 98303
Phone (253) 884-2369
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5040068 | Medicaid | WA |
Other providers in Anderson Island, WA
- Stanley Green
- Laura L Johnston-Mack
- Kobernik Osteopathy Inc.
- Leaf Wellness Coaching
- Pierce County Fire Protection District #27
- Sofia Sabeti
All providers in Anderson Island, WA · Denturist in Washington
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.