Provider Demographics
NPI:1689649196
Name:SKULSKI, CARL CHRISTIAN (DDS)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:CHRISTIAN
Last Name:SKULSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-6806
Mailing Address - Country:US
Mailing Address - Phone:303-499-4915
Mailing Address - Fax:
Practice Address - Street 1:350 BROADWAY ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305-3343
Practice Address - Country:US
Practice Address - Phone:720-304-2600
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69181223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics