Provider Demographics
NPI:1003914995
Name:SKLAR, JEREMY T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:T
Last Name:SKLAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 HERMIT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2722
Mailing Address - Country:US
Mailing Address - Phone:215-872-1053
Mailing Address - Fax:
Practice Address - Street 1:2701 COWPATH RD
Practice Address - Street 2:
Practice Address - City:HATFIELD
Practice Address - State:PA
Practice Address - Zip Code:19440-2300
Practice Address - Country:US
Practice Address - Phone:215-368-7025
Practice Address - Fax:215-368-7026
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0352661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice