Healthcare Provider Details

I. General information

NPI: 1336576206
Provider Name (Legal Business Name): RESNICK ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51241 HIGHWAY 6 AND 24 STE 3
GLENWOOD SPRINGS CO
81601-2577
US

IV. Provider business mailing address

51241 HIGHWAY 6 AND 24 STE 3
GLENWOOD SPRINGS CO
81601-2577
US

V. Phone/Fax

Practice location:
  • Phone: 970-945-8525
  • Fax: 970-928-0921
Mailing address:
  • Phone: 970-945-8525
  • Fax: 970-928-0921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number106353
License Number StateCO

VIII. Authorized Official

Name: JEFFREY BRUCE RESNICK
Title or Position: OWNER/ORTHODONTIST
Credential: D.D.S. M. SC.D.
Phone: 970-945-8525