Healthcare Provider Details

I. General information

NPI: 1386043479
Provider Name (Legal Business Name): MICHAEL SKROBOLA D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2014
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 WISNER AVE
MIDDLETOWN NY
10940-3221
US

IV. Provider business mailing address

180 WISNER AVE
MIDDLETOWN NY
10940-3221
US

V. Phone/Fax

Practice location:
  • Phone: 845-342-1300
  • Fax:
Mailing address:
  • Phone: 845-342-1300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number040174
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: