Provider Demographics
NPI:1548948771
Name:REZICH, MICHAEL TOBIN (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TOBIN
Last Name:REZICH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BETZ RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-3059
Mailing Address - Country:US
Mailing Address - Phone:402-291-3721
Mailing Address - Fax:
Practice Address - Street 1:1201 BETZ RD
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-3059
Practice Address - Country:US
Practice Address - Phone:402-291-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7947122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist