MEDICARE: DR. JONATHAN MINSOO SKELTON DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7103	NV

General Provider Information

NPI Number	:	1336629039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN MINSOO SKELTON DMD

Provider Business Mailing Address
First Line	:	1820 E CRAIG RD STE 102
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3321
Country	:	US
Telephone Number	:	702-680-1009
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 E CRAIG RD STE 102
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-3321
Country	:	US
Telephone Number	:	702-680-1009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	08/21/2018

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