Healthcare Provider Details

I. General information

NPI: 1568618304
Provider Name (Legal Business Name): CHILDSMILES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 SOMME ST 2ND FLOOR
NEWARK NJ
07105
US

IV. Provider business mailing address

66 SOMME ST
NEWARK NJ
07105-3612
US

V. Phone/Fax

Practice location:
  • Phone: 973-578-8788
  • Fax: 973-578-8799
Mailing address:
  • Phone: 973-578-8788
  • Fax: 973-578-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22D102349300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number22D102353600
License Number StateNJ

VIII. Authorized Official

Name: DR. MICHAEL SKOLNICK
Title or Position: PRESIDENT
Credential: DMD
Phone: 973-578-8788