Healthcare Provider Details

I. General information

NPI: 1033366760
Provider Name (Legal Business Name): KENDALL B SKINNER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OMALLEY RD STE 101
ANCHORAGE AK
99515-3083
US

IV. Provider business mailing address

1000 OMALLEY RD STE 101
ANCHORAGE AK
99515-3083
US

V. Phone/Fax

Practice location:
  • Phone: 907-349-0022
  • Fax:
Mailing address:
  • Phone: 907-349-0022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10691
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1134
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: