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General NPI Number Information
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NPI Number | 1295808491
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Entity Type | Individual
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Provider Name | RAYMOND SKINNER MS, DDS
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1277 E MISSOURI AVE SUITE 102
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City | PHOENIX
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State | AZ
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Zip | 85014-2915
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Country | US
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Telephone | 602-266-5896
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Fax | 602-274-6114
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Provider Business Mailing Address
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Address Line | 1277 E MISSOURI AVE SUITE, 102
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City | PHOENIX
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State | AZ
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Zip | 85014-2915
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Country | US
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Telephone | 602-266-5896
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Fax | 602-274-6114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | D1924
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License Number State | AZ
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