Healthcare Provider Details

I. General information

NPI: 1164540407
Provider Name (Legal Business Name): DAVID SKOPP DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 05/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 RCA BLVD STE 105
PALM BEACH GARDENS FL
33410-3335
US

IV. Provider business mailing address

2560 RCA BLVD STE 105
PALM BEACH GARDENS FL
33410-3335
US

V. Phone/Fax

Practice location:
  • Phone: 561-799-5000
  • Fax:
Mailing address:
  • Phone: 561-799-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number10574
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN12464
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: