Healthcare Provider Details

I. General information

NPI: 1811578339
Provider Name (Legal Business Name): ELIZABETH SKOTOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8248 W DEER VALLEY RD
PEORIA AZ
85382-2198
US

IV. Provider business mailing address

8248 W DEER VALLEY RD
PEORIA AZ
85382-2198
US

V. Phone/Fax

Practice location:
  • Phone: 623-935-9873
  • Fax:
Mailing address:
  • Phone: 239-359-8736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011113
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: