Provider Demographics
NPI:1164809273
Name:JEAN RESNEVIC, DMD, LLC
Entity Type:Organization
Organization Name:JEAN RESNEVIC, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RESNEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-745-4591
Mailing Address - Street 1:595 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02828-2137
Mailing Address - Country:US
Mailing Address - Phone:401-949-8160
Mailing Address - Fax:401-949-8163
Practice Address - Street 1:595 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:RI
Practice Address - Zip Code:02828-2137
Practice Address - Country:US
Practice Address - Phone:401-949-8160
Practice Address - Fax:401-949-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty