Organization
BROADWAY ORAL SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL SKOLNICK DMD (OWNER)
(908) 469-9100
Entity
Organization
Contact information
Practice address
65 JEFFERSON AVE, FLOOR 2 SUITE A, ELIZABETH, NJ 07201
(908) 677-5040
Mailing address
65 JEFFERSON AVE, FLOOR 2 SUITE A, ELIZABETH, NJ 07201
(908) 677-5040
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/26/2024
Last updated
11/26/2024
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