Healthcare Provider Details

I. General information

NPI: 1497235030
Provider Name (Legal Business Name): SKOLNICK DENTAL ASSOCIATES SPEC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2018
Last Update Date: 08/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JEFFERSON AVE
ELIZABETH NJ
07201-2474
US

IV. Provider business mailing address

65 JEFFERSON AVE
ELIZABETH NJ
07201-2474
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 TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ETHAN SKOLNICK
Title or Position: OWNER
Credential:
Phone: 908-469-9100