Provider Demographics
NPI:1265582852
Name:SKIBA, JAMES FRIERE SR (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRIERE
Last Name:SKIBA
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2806
Mailing Address - Country:US
Mailing Address - Phone:973-746-7037
Mailing Address - Fax:973-746-6514
Practice Address - Street 1:17 MIDLAND AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2806
Practice Address - Country:US
Practice Address - Phone:973-746-7037
Practice Address - Fax:973-746-6514
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011010001223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU10435Medicare UPIN
NJ171928Medicare ID - Type Unspecified