Provider Demographics
NPI:1396011664
Name:TIMOTHY P. RESUTA, D.M.D., P.C.
Entity Type:Organization
Organization Name:TIMOTHY P. RESUTA, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:RESUTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-351-1035
Mailing Address - Street 1:3280 HOWELL MILL ROAD NW
Mailing Address - Street 2:SUITE 339
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4109
Mailing Address - Country:US
Mailing Address - Phone:404-351-1035
Mailing Address - Fax:404-609-9221
Practice Address - Street 1:3280 HOWELL MILL ROAD NW
Practice Address - Street 2:SUITE 339
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4109
Practice Address - Country:US
Practice Address - Phone:404-351-1035
Practice Address - Fax:404-609-9221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO126951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty