Healthcare Provider Details

I. General information

NPI: 1124780655
Provider Name (Legal Business Name): S4K SCRANTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 10/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 MULBERRY ST
SCRANTON PA
18503-1221
US

IV. Provider business mailing address

313 MULBERRY ST
SCRANTON PA
18503-1221
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-7760
  • Fax:
Mailing address:
  • Phone: 570-346-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHAEL E SKOLNICK
Title or Position: PRESIDENT
Credential: DMD
Phone: 973-715-5963