Healthcare Provider Details

I. General information

NPI: 1699823948
Provider Name (Legal Business Name): STEVEN A SKOCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3996 N FRONTAGE RD
FAYETTEVILLE AR
72703-5122
US

IV. Provider business mailing address

PO BOX 4185
FAYETTEVILLE AR
72702-4185
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-3002
  • Fax: 479-582-2840
Mailing address:
  • Phone: 479-717-1171
  • Fax: 479-582-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number2826
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2826
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: