Provider Demographics
NPI:1194702316
Name:SKIGEN, ANDREW L (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:SKIGEN
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:7711 BAYMEADOWS RD E
Mailing Address - Street 2:STE 7
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9110
Mailing Address - Country:US
Mailing Address - Phone:904-565-1505
Mailing Address - Fax:904-565-1506
Practice Address - Street 1:8708 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6354
Practice Address - Country:US
Practice Address - Phone:904-565-1505
Practice Address - Fax:904-565-1506
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2017-10-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLDN140481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL075368800Medicaid
FL075368800Medicaid
FLU87031Medicare UPIN