MEDICARE: DR. MARIJANA SKOK 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	060437	NY

General Provider Information

NPI Number	:	1356960819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIJANA SKOK DMD

Provider Business Mailing Address
First Line	:	6 STRAWBERRY LANE
Second Line	:
City	:	LORETTE
State	:	MANITOBA
Zip	:	R5K0E7
Country	:	CA
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 N 7TH ST 2ND FLOOR
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11249
Country	:	US
Telephone Number	:	212-686-3686
Fax Number	:

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

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	04/14/2020

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