Healthcare Provider Details

I. General information

NPI: 1699713016
Provider Name (Legal Business Name): LEONARD WARREN SKOPE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 SHERMAN AVE SUITE #402
NEW HAVEN CT
06511-5238
US

IV. Provider business mailing address

136 SHERMAN AVE SUITE #402
NEW HAVEN CT
06511-5238
US

V. Phone/Fax

Practice location:
  • Phone: 203-865-0807
  • Fax: 203-562-4922
Mailing address:
  • Phone: 203-865-0807
  • Fax: 203-562-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number005198
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: