John Wurth Skellenger, DDS
Individual provider Active NPI General Practice Dentistry · Gladstone, MI
NPI 1598852865 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1598852865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 11634 (MI)
- Practice address
- 1103 Delta Ave
Gladstone, MI 49837-0167 - Phone
- (906) 428-1616
- NPI assigned
- Oct 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11634 | MI | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gallery B Smiles | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 11634 | MI | Yes |
Addresses
Primary practice location
1103 Delta Ave
Gladstone, MI 49837-0167
Mailing address
P.O. Box 167
Gladstone, MI 49837-0167
Phone (906) 428-1616
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4043740 | Medicaid | MI |
Other providers in Gladstone, MI
- Scott A Randall
- Matthew Rayeski
- Erik M Rubright
- Joann Leano Santos
- Sierra Schiller
- Keirsten E Smith
- Speak U.P. Speech Therapy
- St Francis Hospital
- Leslie Joeanna Stanek-Nault
- Transition Assisted Living, LLC
All providers in Gladstone, MI · General Practice Dentistry in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.