Healthcare Provider Details

I. General information

NPI: 1174293443
Provider Name (Legal Business Name): ALI L SKOOTI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 06/11/2022
Certification Date: 06/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8089 S LINCOLN ST STE 102
LITTLETON CO
80122-2719
US

IV. Provider business mailing address

8089 S LINCOLN ST STE 102
LITTLETON CO
80122-2719
US

V. Phone/Fax

Practice location:
  • Phone: 303-794-9271
  • Fax:
Mailing address:
  • Phone: 303-794-9271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number00205011
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: