Healthcare Provider Details

I. General information

NPI: 1811083793
Provider Name (Legal Business Name): DR. DANIEL W SKINNER, P.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12509 E MISSION AVE SUITE 101
SPOKANE VALLEY WA
99216-1049
US

IV. Provider business mailing address

12509 E MISSION AVE SUITE 101
SPOKANE VALLEY WA
99216-1049
US

V. Phone/Fax

Practice location:
  • Phone: 509-928-3600
  • Fax: 509-922-7244
Mailing address:
  • Phone: 509-928-3600
  • Fax: 509-922-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberDE00004749
License Number StateWA

VIII. Authorized Official

Name: DANIEL W SKINNER
Title or Position: PRESIDENT
Credential: DDS, MS
Phone: 509-928-3600