Healthcare Provider Details

I. General information

NPI: 1225122476
Provider Name (Legal Business Name): CHARLOTTE ZIEGLER SKELTON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 PIONEER TRL
CHASKA MN
55318-1167
US

IV. Provider business mailing address

1630 UNIVERSITY AVE W
SAINT PAUL MN
55104-3887
US

V. Phone/Fax

Practice location:
  • Phone: 952-361-3740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number261QD0000X
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD12336
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12336
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: