Provider Demographics
NPI:1154578896
Name:SKINNER, CHUCK (DMD)
Entity type:Individual
Prefix:
First Name:CHUCK
Middle Name:
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-1302
Mailing Address - Country:US
Mailing Address - Phone:303-665-7505
Mailing Address - Fax:303-664-9941
Practice Address - Street 1:1760 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-1302
Practice Address - Country:US
Practice Address - Phone:303-665-7505
Practice Address - Fax:303-664-9941
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10514122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist