Healthcare Provider Details

I. General information

NPI: 1932804192
Provider Name (Legal Business Name): ERIK PAUL SKOE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MAIN ST
GREEN BAY WI
54301-5115
US

IV. Provider business mailing address

11711 W BURLEIGH ST
WAUWATOSA WI
53222-3196
US

V. Phone/Fax

Practice location:
  • Phone: 920-431-0345
  • Fax:
Mailing address:
  • Phone: 414-771-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6001701
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: