Healthcare Provider Details

I. General information

NPI: 1881808673
Provider Name (Legal Business Name): JOHN CHARLES SKREKO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6935 JOLIET RD
INDIAN HEAD PARK IL
60525-4370
US

IV. Provider business mailing address

6961 VINE STREET SUITE A
INDIAN HEAD PARK IL
60525-4370
US

V. Phone/Fax

Practice location:
  • Phone: 708-246-1263
  • Fax: 708-246-6953
Mailing address:
  • Phone: 708-246-1263
  • Fax: 708-246-6953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number016367
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: