Provider Demographics
NPI:1962519272
Name:REZNICK, JAY BRIAN (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:BRIAN
Last Name:REZNICK
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 KNIGHTSBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-6732
Mailing Address - Country:US
Mailing Address - Phone:818-269-5625
Mailing Address - Fax:818-269-5625
Practice Address - Street 1:8265 HIGHWAY 92 STE 116
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6520
Practice Address - Country:US
Practice Address - Phone:818-269-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374851223S0112X
GA1236801223S0112X
CAA055148204E00000X
GA1039071223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25364Medicare UPIN
CAWA55148BMedicare ID - Type Unspecified
CAWA55148AMedicare ID - Type UnspecifiedENCINO OFFICE