Provider Demographics
NPI:1164017117
Name:ROSALYN SHKOLNIKOV, DMD, PLLC
Entity Type:Organization
Organization Name:ROSALYN SHKOLNIKOV, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHKOLNIKOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-953-4021
Mailing Address - Street 1:5665 BEELER ST UNIT 140
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-4341
Mailing Address - Country:US
Mailing Address - Phone:720-577-2844
Mailing Address - Fax:720-577-2835
Practice Address - Street 1:5665 BEELER ST UNIT 140
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80238-4341
Practice Address - Country:US
Practice Address - Phone:720-577-2844
Practice Address - Fax:720-577-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000146740Medicaid