Healthcare Provider Details

I. General information

NPI: 1831005628
Provider Name (Legal Business Name): KATHERINE SKILLESTAD, DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 OLD HONEYCUTT RD
FUQUAY VARINA NC
27526-9307
US

IV. Provider business mailing address

5410 GARRETT RD
DURHAM NC
27707-5047
US

V. Phone/Fax

Practice location:
  • Phone: 704-288-7101
  • Fax:
Mailing address:
  • Phone: 704-288-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHERINE SKILLESTAD
Title or Position: OWNER/ORTHODONTIST
Credential: DDS, MS
Phone: 704-288-7101