Provider Demographics
NPI:1336576206
Name:RESNICK ORTHODONTICS
Entity Type:Organization
Organization Name:RESNICK ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS M SCD
Authorized Official - Phone:970-945-8525
Mailing Address - Street 1:51241 HIGHWAY 6 AND 24 STE 3
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-2577
Mailing Address - Country:US
Mailing Address - Phone:970-945-8525
Mailing Address - Fax:970-928-0921
Practice Address - Street 1:51241 HIGHWAY 6 AND 24 STE 3
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-2577
Practice Address - Country:US
Practice Address - Phone:970-945-8525
Practice Address - Fax:970-928-0921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1063531223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty