Provider Demographics
NPI:1679706659
Name:RESNEVIC, JEAN ANDREA (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ANDREA
Last Name:RESNEVIC
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:407-567-9272
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
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24885122300000X
RIDEN03131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist