Provider Demographics
NPI:1881182103
Name:SAMUEL SKURIE, D.D.S., LTD.
Entity Type:Organization
Organization Name:SAMUEL SKURIE, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKURIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-432-0254
Mailing Address - Street 1:170 LAKESIDE PL
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5317
Mailing Address - Country:US
Mailing Address - Phone:847-433-6006
Mailing Address - Fax:
Practice Address - Street 1:1770 1ST ST STE 450
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5602
Practice Address - Country:US
Practice Address - Phone:847-432-0254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-23
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty