Healthcare Provider Details

I. General information

NPI: 1609988625
Provider Name (Legal Business Name): GEORGE S. SKOOG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E NORTHWEST HWY
PALATINE IL
60067-8107
US

IV. Provider business mailing address

850 S KERRY CT
PALATINE IL
60067-7177
US

V. Phone/Fax

Practice location:
  • Phone: 847-359-8732
  • Fax:
Mailing address:
  • Phone: 847-359-8732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: