Provider Demographics
NPI:1972733798
Name:SKOWRONSKI, JAKUB MICHAL (DMD)
Entity type:Individual
Prefix:DR
First Name:JAKUB
Middle Name:MICHAL
Last Name:SKOWRONSKI
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ARGUS LN STE C
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9266
Mailing Address - Country:US
Mailing Address - Phone:704-696-2557
Mailing Address - Fax:
Practice Address - Street 1:106 ARGUS LN STE C
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9266
Practice Address - Country:US
Practice Address - Phone:704-696-2557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88411223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5916647Medicaid