=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740431287
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DRS RESNICK, EGGER, AND TATEL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2008
-----------------------------------------------------
Last Update Date | 10/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1707 SHERMER RD SUITE 202
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-5316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-498-1595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1707 SHERMER RD SUITE 202
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-5316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-498-1595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DDS
-----------------------------------------------------
Name | DR. THOMAS RESNICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-498-1595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 021.000884
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------