Provider Demographics
NPI:1447522727
Name:ADVANCED AESTHETIC DENTISTRY 1 PA
Entity type:Organization
Organization Name:ADVANCED AESTHETIC DENTISTRY 1 PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RESNANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-458-1583
Mailing Address - Street 1:1701 E HALLANDALE BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-4621
Mailing Address - Country:US
Mailing Address - Phone:954-458-1583
Mailing Address - Fax:954-458-4078
Practice Address - Street 1:1701 E HALLANDALE BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4621
Practice Address - Country:US
Practice Address - Phone:954-458-1583
Practice Address - Fax:954-458-4078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN165961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty