Healthcare Provider Details

I. General information

NPI: 1740621036
Provider Name (Legal Business Name): DON E. SKAFF, DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2013
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MACCORKLE AVE SE SUITE C
CHARLESTON WV
25304-1835
US

IV. Provider business mailing address

4502 MACCORKLE AVE SE SUITE C
CHARLESTON WV
25304-1835
US

V. Phone/Fax

Practice location:
  • Phone: 304-926-9260
  • Fax: 304-926-9266
Mailing address:
  • Phone: 304-926-9260
  • Fax: 304-926-9266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2869
License Number StateWV

VIII. Authorized Official

Name: DR. DON E SKAFF
Title or Position: OWNER
Credential: DDS
Phone: 304-926-9260