Provider Demographics
NPI:1639617707
Name:RESNEVIC FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:RESNEVIC FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT DESK
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESNEVIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-567-0500
Mailing Address - Street 1:895 PUTNAM PIKE
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-1471
Mailing Address - Country:US
Mailing Address - Phone:401-567-0500
Mailing Address - Fax:401-567-9272
Practice Address - Street 1:895 PUTNAM PIKE
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-1471
Practice Address - Country:US
Practice Address - Phone:401-567-0500
Practice Address - Fax:401-567-9272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty