Healthcare Provider Details

I. General information

NPI: 1982723680
Provider Name (Legal Business Name): PAUL J. SKOMSKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 N MAGNOLIA AVE STE A
ORLANDO FL
32801-1653
US

IV. Provider business mailing address

338 N MAGNOLIA AVE STE A
ORLANDO FL
32801-1653
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-3688
  • Fax: 407-648-8306
Mailing address:
  • Phone: 407-648-3688
  • Fax: 407-648-8306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN0011368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: