Healthcare Provider Details

I. General information

NPI: 1780925081
Provider Name (Legal Business Name): SKOLNICK DENTAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 08/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E JERSEY ST
ELIZABETH NJ
07201-2406
US

IV. Provider business mailing address

1124 E JERSEY ST
ELIZABETH NJ
07201-2406
US

V. Phone/Fax

Practice location:
  • Phone: 908-469-9100
  • Fax:
Mailing address:
  • Phone: 908-469-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number22DI02349301
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22DI02353601
License Number StateNJ

VIII. Authorized Official

Name: MICHAEL SKOLNICK
Title or Position: PRESIDENT
Credential: DMD
Phone: 908-469-9100