Healthcare Provider Details

I. General information

NPI: 1710960737
Provider Name (Legal Business Name): PETER M SKOLER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 09/02/2010
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 STREET SUITE 307
QUINCY MA
02169-0907
US

V. Phone/Fax

Practice location:
  • Phone: 617-770-3838
  • Fax: 617-786-8254
Mailing address:
  • Phone: 617-770-3838
  • Fax: 617-786-8254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14462
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: