Provider Demographics
NPI:1184099251
Name:CHILD SMILES SPEC LLC
Entity type:Organization
Organization Name:CHILD SMILES SPEC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOLNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-578-8788
Mailing Address - Street 1:67-73 FILLMORE ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-2406
Mailing Address - Country:US
Mailing Address - Phone:908-469-9100
Mailing Address - Fax:
Practice Address - Street 1:67-73 FILLMORE STREET
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105
Practice Address - Country:US
Practice Address - Phone:908-469-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty