Healthcare Provider Details

I. General information

NPI: 1427797042
Provider Name (Legal Business Name): CLAIRE SKACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2457 OAKMONT WAY
EUGENE OR
97401-6460
US

IV. Provider business mailing address

1863 10TH ST APT A
SANTA MONICA CA
90404-4534
US

V. Phone/Fax

Practice location:
  • Phone: 541-484-2046
  • Fax:
Mailing address:
  • Phone: 503-547-3858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD11614
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: