Provider Demographics
NPI:1366957862
Name:GREGG S RESNICK DDS
Entity type:Organization
Organization Name:GREGG S RESNICK DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:S
Authorized Official - Last Name:RESNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-354-4884
Mailing Address - Street 1:110 ARBOR LN
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-1302
Mailing Address - Country:US
Mailing Address - Phone:989-354-4884
Mailing Address - Fax:
Practice Address - Street 1:110 ARBOR LN
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-1302
Practice Address - Country:US
Practice Address - Phone:989-354-4884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901013806261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1740294784Medicaid