Provider Demographics
NPI:1285723676
Name:SKIERKOWSKI, MICHELLE Y (DDS, MS)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:Y
Last Name:SKIERKOWSKI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:Y
Other - Last Name:KURKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:6426 SW BURLINGAME PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2686
Mailing Address - Country:US
Mailing Address - Phone:734-645-9876
Mailing Address - Fax:
Practice Address - Street 1:11790 SW BARNES RD
Practice Address - Street 2:280
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5934
Practice Address - Country:US
Practice Address - Phone:503-626-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019090122300000X
WADE 601132281223P0221X
ORD95951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist