Provider Demographics
NPI:1215137609
Name:SKALE, DARRYL ARLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRYL
Middle Name:ARLEN
Last Name:SKALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 MEADOW RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3698
Mailing Address - Country:US
Mailing Address - Phone:847-272-1072
Mailing Address - Fax:
Practice Address - Street 1:1220 MEADOW RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3698
Practice Address - Country:US
Practice Address - Phone:847-272-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-016854-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice