Provider Demographics
NPI:1457481996
Name:RESNICK, MARC GARY (DDS)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:GARY
Last Name:RESNICK
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 1:1500 TUNDRA AVE
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-4411
Mailing Address - Country:US
Mailing Address - Phone:303-946-5154
Mailing Address - Fax:
Practice Address - Street 1:126 E 29TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-2724
Practice Address - Country:US
Practice Address - Phone:970-635-4353
Practice Address - Fax:970-635-4355
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COG3541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice