Healthcare Provider Details

I. General information

NPI: 1841670148
Provider Name (Legal Business Name): MICHAEL JOSEPH SKOVIRA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OLD TROLLEY RD
SUMMERVILLE SC
29485-5686
US

IV. Provider business mailing address

600 OLD TROLLEY RD
SUMMERVILLE SC
29485-5686
US

V. Phone/Fax

Practice location:
  • Phone: 843-486-2170
  • Fax:
Mailing address:
  • Phone: 843-486-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDGD.8541 GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: