Healthcare Provider Details

I. General information

NPI: 1689881930
Provider Name (Legal Business Name): ERIC S SKINNER DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 N PECOS RD STE D
HENDERSON NV
89074-3300
US

IV. Provider business mailing address

PO BOX 17179
IRVINE CA
92623-7179
US

V. Phone/Fax

Practice location:
  • Phone: 702-438-2500
  • Fax: 702-617-3409
Mailing address:
  • Phone: 949-567-3176
  • Fax: 949-567-3185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2991
License Number StateNV

VIII. Authorized Official

Name: DR. ERIC S SKINNER
Title or Position: PC HOLDER
Credential: DDS
Phone: 702-438-2500