Healthcare Provider Details

I. General information

NPI: 1922918341
Provider Name (Legal Business Name): ROCHELLE SKINNER DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10913 VENICE BLVD
LOS ANGELES CA
90034-7009
US

IV. Provider business mailing address

10913 VENICE BLVD
LOS ANGELES CA
90034-7009
US

V. Phone/Fax

Practice location:
  • Phone: 310-895-9885
  • Fax: 424-326-8033
Mailing address:
  • Phone: 310-895-9885
  • Fax: 424-326-8033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: ROCHELLE SKINNER
Title or Position: PRESIDENT
Credential: DDS
Phone: 816-616-6009