MEDICARE: DR. STEPHEN BRIAN RESNICK DMD

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	5090	AZ

General Provider Information

NPI Number	:	1780765651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN BRIAN RESNICK DMD

Provider Business Mailing Address
First Line	:	7054 E COCHISE RD
Second Line	:	B-215
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-4546
Country	:	US
Telephone Number	:	480-368-2222
Fax Number	:	480-368-6139

Provider Business Practice Location Address
First Line	:	7054 E COCHISE RD
Second Line	:	B-215
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85253-4546
Country	:	US
Telephone Number	:	480-368-2222
Fax Number	:	480-368-6139

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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