Healthcare Provider Details

I. General information

NPI: 1609691260
Provider Name (Legal Business Name): ROSS M. WEZMAR, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2024
Last Update Date: 11/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 N 9TH AVE
SCRANTON PA
18504
US

IV. Provider business mailing address

313 MULBERRY ST
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 570-343-8885
  • Fax:
Mailing address:
  • Phone: 570-346-7760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice 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: MR. MICHAEL SKOLNICK
Title or Position: OWNER
Credential: DMD
Phone: 908-469-9100