Provider Demographics
NPI:1033276530
Name:CHILDRENS DENTAL CENTER
Entity Type:Organization
Organization Name:CHILDRENS DENTAL CENTER
Other - Org Name:PARKWAY ORTHODONTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JB
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIBINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-332-1095
Mailing Address - Street 1:3813 S KIWANIS CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4266
Mailing Address - Country:US
Mailing Address - Phone:605-332-1095
Mailing Address - Fax:605-335-7618
Practice Address - Street 1:3813 S KIWANIS CIR
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4266
Practice Address - Country:US
Practice Address - Phone:605-332-1095
Practice Address - Fax:605-335-7618
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM9631223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD7806330Medicaid