Provider Demographics
NPI:1710779343
Name:PATERSON DENTAL SPEC, LLC
Entity type:Organization
Organization Name:PATERSON DENTAL SPEC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:908-469-9100
Mailing Address - Street 1:370 BROADWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501
Mailing Address - Country:US
Mailing Address - Phone:973-221-8751
Mailing Address - Fax:
Practice Address - Street 1:370 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07501
Practice Address - Country:US
Practice Address - Phone:973-221-8751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty