Provider Demographics
NPI:1568511335
Name:SKULMAN, GREGORY E (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:E
Last Name:SKULMAN
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 1:12344 INWOOD RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-8023
Mailing Address - Country:US
Mailing Address - Phone:214-361-6088
Mailing Address - Fax:214-361-4905
Practice Address - Street 1:12344 INWOOD RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-8023
Practice Address - Country:US
Practice Address - Phone:214-361-6088
Practice Address - Fax:214-361-4905
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice