Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | LS014616 | MI |
Y | 204E00000X | Oral & Maxillofacial Surgeon | LS014616 | MI |
NPI | 1437174786 |
---|---|
Provider Name | Dr. Larry J Skoczylas |
First Address | Midland, MI 48640-7358 |
Second Address | Midland, MI 48640-7358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 10/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2847912 | (05) | MI |
2993779 | (05) | MI |
U26760 | (02) | MI |