Provider Demographics
NPI:1427690098
Name:SKELTON DDS INC
Entity type:Organization
Organization Name:SKELTON DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SKELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-518-5774
Mailing Address - Street 1:785 HANA WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3885
Mailing Address - Country:US
Mailing Address - Phone:916-983-6051
Mailing Address - Fax:
Practice Address - Street 1:785 HANA WAY STE 105
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3885
Practice Address - Country:US
Practice Address - Phone:916-983-6051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental