Healthcare Provider Details

I. General information

NPI: 1093801540
Provider Name (Legal Business Name): BARRY NEIL RESNICK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1177 ASHLEY BLVD
NEW BEDFORD MA
02745-2419
US

IV. Provider business mailing address

1177 ASHLEY BLVD
NEW BEDFORD MA
02745-2419
US

V. Phone/Fax

Practice location:
  • Phone: 508-998-2103
  • Fax: 508-998-0839
Mailing address:
  • Phone: 508-998-2103
  • Fax: 508-998-0839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number012676
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: