Provider Demographics
NPI:1801381686
Name:SKVORAK, JOHN STANLEY III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STANLEY
Last Name:SKVORAK
Suffix:III
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 1:290 BRIDGTON RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3753
Mailing Address - Country:US
Mailing Address - Phone:207-797-7400
Mailing Address - Fax:
Practice Address - Street 1:290 BRIDGTON RD
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3753
Practice Address - Country:US
Practice Address - Phone:207-797-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist