Vladislav Aleksandrovich Reznichenko, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DGD.10221 Issued in SC

Practice address

1505 Red Bank Rd
Goose Creek, SC 29445-4516

Phone

(843) 824-8742

NPI assigned

Jun 6, 2022

Last updated

Jun 6, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Dr. Keith B. Flynn DMD PA

  • General Practice Dentistry
  • Goose Creek, SC
  • NPI 1134311830
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654473600000",
    "number": "1659000859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 CONWAY CIR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294868110",
            "telephone_number": "864-541-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 RED BANK RD",
            "city": "GOOSE CREEK",
            "state": "SC",
            "postal_code": "294454516",
            "telephone_number": "843-824-8742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZNICHENKO",
        "first_name": "VLADISLAV",
        "middle_name": "ALEKSANDROVICH",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-06",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "DGD.10221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Gerard Regan, DC
• Regina Rose Life Center
• Renewed Minds Counseling, LLC
• Restored Wellness
• William Grant Reynolds, DMD
• Erica Rice
• Myra Lynn Richardson, RBT
• Kelly Richmond Revy, OD
• Patricia Marie Ripp, PSY.D.
• RJR Dentistry LLC (Sensational Smiles of Charleston)

• General Practice Dentistry in Goose Creek, SC
• Providers in Goose Creek, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.