Basic Information
| Provider Information | |||||||||
| NPI: | 1700268539 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RESLOW | ||||||||
| FirstName: | PAULETTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 146 HAMILTON DR UPPR | ||||||||
| Address2: | |||||||||
| City: | SNYDER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142264741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162970798 | ||||||||
| FaxNumber: | 7162970998 | ||||||||
| Practice Location | |||||||||
| Address1: | 9812 LOCKPORT RD | ||||||||
| Address2: | |||||||||
| City: | NIAGARA FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 143041114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162970798 | ||||||||
| FaxNumber: | 7162970998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2015 | ||||||||
| LastUpdateDate: | 06/29/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 022520 | NY | Y | Dental Providers | Dental Hygienist |
ID Information
| ID | Type | State | Issuer | Description | 022520 | 01 | NY | NEW YORK STATE LICENSE | OTHER |