Healthcare Provider Details

I. General information

NPI: 1104731884
Provider Name (Legal Business Name): TINI TEETH PEDIATRIC DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 CRITTER CT
ONALASKA WI
54650-8656
US

IV. Provider business mailing address

801 CRITTER CT
ONALASKA WI
54650-8656
US

V. Phone/Fax

Practice location:
  • Phone: 608-498-4101
  • Fax: 608-498-4103
Mailing address:
  • Phone: 608-498-4101
  • Fax: 608-498-4103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ERIK SKOE
Title or Position: OWNER DOCTOR
Credential: DDS
Phone: 608-498-4101