Provider Demographics
NPI:1972007961
Name:SKINNER, TREVOR MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:MICHAEL
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 1:201 WALTERSCHEID BLVD APT 6-308
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82007-2046
Mailing Address - Country:US
Mailing Address - Phone:307-887-5249
Mailing Address - Fax:
Practice Address - Street 1:60 N MERCER AVE
Practice Address - Street 2:
Practice Address - City:SHARPSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16150-2244
Practice Address - Country:US
Practice Address - Phone:724-247-0167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY14941223G0001X
PADS044062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice