Healthcare Provider Details

I. General information

NPI: 1689797938
Provider Name (Legal Business Name): SKOLER & DIMARZIO ORTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CONGRESS ST SUITE 307
QUINCY MA
02169-0907
US

IV. Provider business mailing address

300 CONGRESS ST SUITE 307
QUINCY MA
02169-0907
US

V. Phone/Fax

Practice location:
  • Phone: 617-770-3838
  • Fax:
Mailing address:
  • Phone: 617-770-3838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PETER MATTHEW SKOLER
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 617-770-3838