Provider Demographics
NPI:1033129069
Name:JOHN SKVORAK JR., D.M.D.
Entity Type:Organization
Organization Name:JOHN SKVORAK JR., D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SKVORAK
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-797-7400
Mailing Address - Street 1:390 BRIDGTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3722
Mailing Address - Country:US
Mailing Address - Phone:207-797-7400
Mailing Address - Fax:207-878-9673
Practice Address - Street 1:390 BRIDGTON RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3722
Practice Address - Country:US
Practice Address - Phone:207-797-7400
Practice Address - Fax:207-878-9673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3303122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty