Provider Demographics
NPI:1962422204
Name:ROBERT L SKINNER DDS PA
Entity type:Organization
Organization Name:ROBERT L SKINNER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-452-3368
Mailing Address - Street 1:2414 S 58TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-3827
Mailing Address - Country:US
Mailing Address - Phone:479-452-3368
Mailing Address - Fax:479-452-3316
Practice Address - Street 1:2414 S 58TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-3827
Practice Address - Country:US
Practice Address - Phone:479-452-3368
Practice Address - Fax:479-452-3316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR27521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty