Provider Demographics
NPI:1609767987
Name:REZAC, ALEXIS (DDS)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:REZAC
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42929 307TH ST
Mailing Address - Street 2:
Mailing Address - City:TABOR
Mailing Address - State:SD
Mailing Address - Zip Code:57063-5808
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:134 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:MORTON
Practice Address - State:IL
Practice Address - Zip Code:61550-1532
Practice Address - Country:US
Practice Address - Phone:309-263-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190362601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice