Ehab Aly Nour Rezk, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12323 Issued in MN

Practice address

20 5TH St SE
Cook, MN 55723-9702

Phone

(218) 666-5958

Fax

(218) 361-3149

NPI assigned

Nov 23, 2015

Last updated

Nov 23, 2015By 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

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1448236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448236800000",
    "number": "1912371311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 5TH ST SE",
            "city": "COOK",
            "state": "MN",
            "postal_code": "557239702",
            "telephone_number": "218-666-5958",
            "fax_number": "218-361-3149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 5TH ST SE",
            "city": "COOK",
            "state": "MN",
            "postal_code": "557239702",
            "telephone_number": "218-666-5958",
            "fax_number": "218-361-3149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REZK",
        "first_name": "EHAB",
        "middle_name": "ALY NOUR",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-11-23",
        "last_updated": "2015-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeri Mills, M.D.
• Craig Martin Mrosak, D.D.S.
• Northland Anesthesia Associates
• Ol-US Cook, LLC
• Louis Frank Pius, DDS
• Carrie Sell, D.C.
• Elizabeth Simensen, LIC. AC. MAOM
• Timothy Sprouls, DDS
• Duane Mathew Sushoreba, D.D.S.
• Michael Morris Talberg, DDS

• General Practice Dentistry in Cook, MN
• Providers in Cook, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.