Ehab Aly Nour Rezk, DDS
Individual provider Active NPI General Practice Dentistry · Cook, MN
NPI 1912371311 · NPPES record last updated Nov 23, 2015
Key facts
- NPI
- 1912371311
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D12323 (MN)
- Practice address
- 20 5TH St SE
Cook, MN 55723-9702 - Phone
- (218) 666-5958
- Fax
- (218) 361-3149
- NPI assigned
- Nov 23, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161109000271 | MN | Order and Referring Only - Family Practice |
6305125691 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D12323 | MN | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D12323 | MN | Yes |
Addresses
Primary practice location
20 5TH St SE
Cook, MN 55723-9702
Mailing address
20 5TH St SE
Cook, MN 55723-9702
Phone (218) 666-5958
Other providers in Cook, MN
- Jeri Mills
- Craig Martin Mrosak
- Northland Anesthesia Associates
- Ol-US Cook, LLC
- Louis Frank Pius
- Carrie Sell
- Elizabeth Simensen
- Timothy Sprouls
- Duane Mathew Sushoreba
- Michael Morris Talberg
All providers in Cook, MN · General Practice Dentistry in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.