Healthcare Provider Details

I. General information

NPI: 1972733798
Provider Name (Legal Business Name): JAKUB MICHAL SKOWRONSKI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 ARGUS LN STE C
MOORESVILLE NC
28117-9266
US

IV. Provider business mailing address

106 ARGUS LN STE C
MOORESVILLE NC
28117-9266
US

V. Phone/Fax

Practice location:
  • Phone: 704-696-2557
  • Fax:
Mailing address:
  • Phone: 704-696-2557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8841
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8841
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: