Healthcare Provider Details

I. General information

NPI: 1003320003
Provider Name (Legal Business Name): SKYLA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 ADDISON DR STE 111
ROCK HILL SC
29730-7061
US

IV. Provider business mailing address

586 FOSTER HEIGHTS DR
LANCASTER SC
29720-9218
US

V. Phone/Fax

Practice location:
  • Phone: 803-832-4446
  • Fax:
Mailing address:
  • Phone: 803-832-4446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number3431
License Number StateSC

VIII. Authorized Official

Name: DR. PATRICIA KING RUCKER
Title or Position: PRESIDENT
Credential: DDS
Phone: 803-832-4446