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General NPI Number Information
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NPI Number | 1144686320
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Entity Type | Organization
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Legal Business Name | RAYMOND J SKOSKY, DDS,LLC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 5530 VIRGINIA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1939
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Country | US
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Telephone | 314-353-0263
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Fax | 314-353-0263
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Provider Business Mailing Address
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Address Line | 5530 VIRGINIA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1939
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Country | US
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Telephone | 314-353-0263
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Fax | 314-353-0263
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | RAYMOND J SKOSKY
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Credential | DDS
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Telephone | 314-353-0263
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 014508
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License Number State | MO
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