Healthcare Provider Details

I. General information

NPI: 1194550921
Provider Name (Legal Business Name): DEANNA M SKOWRONSKI DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37300 SCHOENHERR RD
STERLING HEIGHTS MI
48312-2312
US

IV. Provider business mailing address

37300 SCHOENHERR RD
STERLING HEIGHTS MI
48312-2312
US

V. Phone/Fax

Practice location:
  • Phone: 586-977-8413
  • Fax: 586-977-8512
Mailing address:
  • Phone: 586-977-8413
  • Fax: 586-977-8512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901602096
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: