Healthcare Provider Details

I. General information

NPI: 1184739773
Provider Name (Legal Business Name): RANDOLPH R RESNIK DMD,MDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 BOWER HILL RD
PITTSBURGH PA
15243-1324
US

IV. Provider business mailing address

138 BITTERSWEET CIR
VENETIA PA
15367-1000
US

V. Phone/Fax

Practice location:
  • Phone: 412-279-7744
  • Fax: 412-279-7904
Mailing address:
  • Phone: 724-942-4611
  • Fax: 412-279-7904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDS026440-L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN14014
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: