Healthcare Provider Details

I. General information

NPI: 1174654982
Provider Name (Legal Business Name): MONA E. SKAFF DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 26610 BAVARIA DENTAL ACTIVITY CREDENTIALS OFFICE
APO AE NY
09244
US

IV. Provider business mailing address

UNIT 26610 BAVARIA DENTAL ACTIVITY CREDENTIALS OFFICE
APO AE NY
09244
US

V. Phone/Fax

Practice location:
  • Phone: 931-804-3933
  • Fax: 931-804-2524
Mailing address:
  • Phone: 931-804-3933
  • Fax: 931-804-2524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53389
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberWV3377
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: