Provider Demographics
NPI:1184642845
Name:RESAR, TERRANCE A (DDS)
Entity type:Individual
Prefix:
First Name:TERRANCE
Middle Name:A
Last Name:RESAR
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 1:37190 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1500
Mailing Address - Country:US
Mailing Address - Phone:440-934-4900
Mailing Address - Fax:440-934-4904
Practice Address - Street 1:37190 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1500
Practice Address - Country:US
Practice Address - Phone:440-934-4900
Practice Address - Fax:440-934-4904
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0215971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2496599Medicaid