Provider Demographics
NPI:1740294784
Name:RESNICK, GREGG STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:STEPHEN
Last Name:RESNICK
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 1:110 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1302
Mailing Address - Country:US
Mailing Address - Phone:989-354-4884
Mailing Address - Fax:
Practice Address - Street 1:110 ARBOR LN
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1302
Practice Address - Country:US
Practice Address - Phone:989-354-4884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI138061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice