Healthcare Provider Details

I. General information

NPI: 1689649196
Provider Name (Legal Business Name): CARL CHRISTIAN SKULSKI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 BROADWAY ST SUITE 201
BOULDER CO
80305-3343
US

IV. Provider business mailing address

2640 BRIARWOOD DR
BOULDER CO
80305-6806
US

V. Phone/Fax

Practice location:
  • Phone: 720-304-2600
  • Fax:
Mailing address:
  • Phone: 303-499-4915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number6918
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: