Provider Demographics
NPI:1255449799
Name:SKELLY & ZAGER DDS PC
Entity type:Organization
Organization Name:SKELLY & ZAGER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:ZAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-425-1610
Mailing Address - Street 1:32788 FIVE MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-425-1610
Mailing Address - Fax:734-425-1335
Practice Address - Street 1:32788 FIVE MILE ROAD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-425-1610
Practice Address - Fax:734-425-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI799851OtherUNITED CONCORDIA
MIJ800169OtherBCBS