MEDICARE: DR. MICHAEL RESNICK DDS MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN17828	FL

General Provider Information

NPI Number	:	1164575734
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL RESNICK DDS MPH

Provider Business Mailing Address
First Line	:	3349 WATER OAK ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6391
Country	:	US
Telephone Number	:	954-986-9684
Fax Number	:	954-208-0420

Provider Business Practice Location Address
First Line	:	3349 WATER OAK ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-6391
Country	:	US
Telephone Number	:	646-896-9503
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	09/26/2011

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