Provider Demographics
NPI:1083788384
Name:SKALNIK, DAVID GRANT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GRANT
Last Name:SKALNIK
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 1:6525 OLD GREENSBORO RD
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-5993
Mailing Address - Country:US
Mailing Address - Phone:205-248-6242
Mailing Address - Fax:205-752-1929
Practice Address - Street 1:6525 OLD GREENSBORO RD
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-5993
Practice Address - Country:US
Practice Address - Phone:205-248-6242
Practice Address - Fax:205-752-1929
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist