Provider Demographics
NPI:1861414120
Name:REZZO, THOMAS PATRICK (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:PATRICK
Last Name:REZZO
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 1:18399 VENTURA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6406
Mailing Address - Country:US
Mailing Address - Phone:818-342-6139
Mailing Address - Fax:818-344-1361
Practice Address - Street 1:18399 VENTURA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-6406
Practice Address - Country:US
Practice Address - Phone:818-342-6139
Practice Address - Fax:818-344-1361
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA29431OtherSTATE DENTAL LICENSE #