Provider Demographics
NPI:1699823948
Name:SKOCH, STEVEN A (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:A
Last Name:SKOCH
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:PO BOX 4185
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-4185
Mailing Address - Country:US
Mailing Address - Phone:479-717-1171
Mailing Address - Fax:479-582-2840
Practice Address - Street 1:3996 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5122
Practice Address - Country:US
Practice Address - Phone:479-582-3002
Practice Address - Fax:479-582-2840
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2826204E00000X, 1223S0112X, 204E00000X
MO20020028929204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR234282400OtherDEPT OF LABOR WORKERS COM
AR136420679Medicaid
AR985779OtherUNITED CONCORDIA
AR58187OtherBCBS
AR136420679Medicaid
AR58187OtherBCBS
AR985779OtherUNITED CONCORDIA
AR234282400OtherDEPT OF LABOR WORKERS COM