Healthcare Provider Details

I. General information

NPI: 1871408351
Provider Name (Legal Business Name): MILLER SKINNER AND DASTRUP DENTAL AND ORTHODONTICS CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 W 26TH ST
MERCED CA
95340-2837
US

IV. Provider business mailing address

552 W 26TH ST
MERCED CA
95340-2837
US

V. Phone/Fax

Practice location:
  • Phone: 480-399-3588
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEREMY SKINNER
Title or Position: OWNER
Credential: DDS
Phone: 480-399-3588