Provider Demographics
NPI:1598890279
Name:SKALESKI, CYNTHIA LINDA (RDH REGISTERED DENTA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LINDA
Last Name:SKALESKI
Suffix:
Gender:F
Credentials:RDH REGISTERED DENTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 SOUTH LOCUST STREET
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303
Mailing Address - Country:US
Mailing Address - Phone:920-494-7730
Mailing Address - Fax:
Practice Address - Street 1:1711 SHAWANO AVENUE
Practice Address - Street 2:DENTAL ARTS ASSOCIATES OF GREEN BAY LTD
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303
Practice Address - Country:US
Practice Address - Phone:920-494-9541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4443016124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist