Provider Demographics
NPI:1821095092
Name:RESNICK, MITCHELL B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:B
Last Name:RESNICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 NEWTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2010
Mailing Address - Country:US
Mailing Address - Phone:413-538-9604
Mailing Address - Fax:413-534-3533
Practice Address - Street 1:488 NEWTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2010
Practice Address - Country:US
Practice Address - Phone:413-538-9604
Practice Address - Fax:413-534-3533
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 12187-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice