1689881930 NPI number — ERIC S SKINNER DDS LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689881930 NPI number — ERIC S SKINNER DDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERIC S SKINNER DDS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689881930
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17179
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92623-7179
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-567-3176
Provider Business Mailing Address Fax Number:
949-567-3185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 N PECOS RD
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89074-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-438-2500
Provider Business Practice Location Address Fax Number:
702-617-3409
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SKINNER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PC HOLDER
Authorized Official Telephone Number:
702-438-2500

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  2991 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com