Provider Demographics
NPI:1881879963
Name:SKORCZESKI, JOHN PAUL (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PAUL
Last Name:SKORCZESKI
Suffix:
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 1:1267 S MILL ST
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62263-2004
Mailing Address - Country:US
Mailing Address - Phone:618-327-4348
Mailing Address - Fax:618-327-9138
Practice Address - Street 1:1267 S MILL ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:IL
Practice Address - Zip Code:62263-2004
Practice Address - Country:US
Practice Address - Phone:618-327-4348
Practice Address - Fax:618-327-9138
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0179211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice