Provider Demographics
NPI:1407991581
Name:SKOWRON JR., JOHN J
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:SKOWRON JR.
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-2307
Mailing Address - Country:US
Mailing Address - Phone:847-446-0970
Mailing Address - Fax:847-446-0979
Practice Address - Street 1:575 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-2307
Practice Address - Country:US
Practice Address - Phone:847-446-0970
Practice Address - Fax:847-446-0979
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist