Healthcare Provider Details

I. General information

NPI: 1184580656
Provider Name (Legal Business Name): SKYLINE DENTAL OF WAYNE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 HAMBURG TPKE UNIT 14
WAYNE NJ
07470-2098
US

IV. Provider business mailing address

133 JANWICH DR
MORGANVILLE NJ
07751-1480
US

V. Phone/Fax

Practice location:
  • Phone: 732-822-7313
  • Fax:
Mailing address:
  • Phone: 732-822-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALIANA HENKIN
Title or Position: OWNER
Credential:
Phone: 732-822-7313