Active NPI
Jerrold B Resnick, D.M.D.
- General Practice Dentistry
- St Petersburg, FL
National Provider Identifier
1265412852
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN7584
- Practice address
- 6450 Central Ave
St Petersburg, FL 33707-1329 - Phone
- (727) 347-6450
- Fax
- (727) 347-7906
- NPI assigned
- Jan 19, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN7584 | FL | Primary |
Addresses
Primary practice location
6450 Central Ave
St Petersburg, FL 33707-1329
Mailing address
6450 Central Ave
St Petersburg, FL 33707-1329
Phone (727) 347-6450
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN7584 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vivian Quesada-Fox, DMD, PA | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- St Petersburg, FL
- NPI 1578999652
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184630400000",
"number": "1265412852",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6450 CENTRAL AVE",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337071329",
"telephone_number": "727-347-6450",
"fax_number": "727-347-7906"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6450 CENTRAL AVE",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337071329",
"telephone_number": "727-347-6450",
"fax_number": "727-347-7906"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RESNICK",
"first_name": "JERROLD",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-19",
"last_updated": "2007-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN7584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.