Healthcare Provider Details

I. General information

NPI: 1881879963
Provider Name (Legal Business Name): JOHN PAUL SKORCZESKI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2008
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 S MILL ST
NASHVILLE IL
62263-2004
US

IV. Provider business mailing address

1267 S MILL ST
NASHVILLE IL
62263-2004
US

V. Phone/Fax

Practice location:
  • Phone: 618-327-4348
  • Fax: 618-327-9138
Mailing address:
  • Phone: 618-327-4348
  • Fax: 618-327-9138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019-017921
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: