Provider Demographics
NPI:1104374917
Name:DYNAMIC DENTAL LLC.
Entity Type:Organization
Organization Name:DYNAMIC DENTAL LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:A
Authorized Official - Last Name:RESASCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-646-6004
Mailing Address - Street 1:60 LORRAINE CT.
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7170 E MCDONALD DR STE 12
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85253-5424
Practice Address - Country:US
Practice Address - Phone:480-646-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty