Healthcare Provider Details

I. General information

NPI: 1821156605
Provider Name (Legal Business Name): CHARLES S SKOGLUND D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 S 13TH ST
NORFOLK NE
68701-4966
US

IV. Provider business mailing address

513 S 13TH ST
NORFOLK NE
68701-4966
US

V. Phone/Fax

Practice location:
  • Phone: 402-379-2775
  • Fax: 402-379-0120
Mailing address:
  • Phone: 402-379-2775
  • Fax: 402-379-0120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4961
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: