Healthcare Provider Details

I. General information

NPI: 1437012861
Provider Name (Legal Business Name): PEARLY WHITES PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2025
Last Update Date: 12/03/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 SPRINGFIELD AVE 2ND FLOOR
BERKELEY HEIGHTS NJ
07922
US

IV. Provider business mailing address

515 SPRINGFIELD AVE 2ND FLOOR
BERKELEY HEIGHTS NJ
07922
US

V. Phone/Fax

Practice location:
  • Phone: 973-554-4565
  • Fax:
Mailing address:
  • Phone: 973-554-4565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL SKOLNICK
Title or Position: OWNER
Credential: DMD
Phone: 908-469-9100