Provider Demographics
NPI:1962512905
Name:SKINNER, GREGORY C (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:C
Last Name:SKINNER
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 1:250 S LYON AVE
Mailing Address - Street 2:SUITE #B
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3850
Mailing Address - Country:US
Mailing Address - Phone:951-658-2354
Mailing Address - Fax:951-929-8955
Practice Address - Street 1:250 S LYON AVE
Practice Address - Street 2:SUITE #B
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-3850
Practice Address - Country:US
Practice Address - Phone:951-658-2354
Practice Address - Fax:951-929-8955
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA297971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice