Healthcare Provider Details

I. General information

NPI: 1124308812
Provider Name (Legal Business Name): FOTIOS A. SKORDAS M.S., D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: F. A. SKORDAS M.S., D.D.S., PL

II. Dates (important events)

Enumeration Date: 08/25/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7129 CURTISS AVE #2
SARASOTA FL
34231-8080
US

IV. Provider business mailing address

7129 CURTISS AVE #2
SARASOTA FL
34231-8080
US

V. Phone/Fax

Practice location:
  • Phone: 941-922-8811
  • Fax:
Mailing address:
  • Phone: 941-922-8811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN13645
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: