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General NPI Number Information
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NPI Number | 1497988588
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Entity Type | Organization
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Legal Business Name | SKINNER OSSAKOW & ASSOCIATES
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Dates
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Enumeration Date | 08/24/2009
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Last Update Date | 08/24/2009
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Provider Practice Location Address
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Address Line | 5651 STONE RD
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City | CENTREVILLE
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State | VA
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Zip | 20120-1618
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Country | US
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Telephone | 703-830-3092
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Fax | 703-930-0601
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Provider Business Mailing Address
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Address Line | 5651 STONE RD
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City | CENTREVILLE
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State | VA
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Zip | 20120-1618
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Country | US
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Telephone | 703-830-3092
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Fax | 703-930-0601
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | TARA GOLDEN
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Credential |
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Telephone | 703-830-3092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401410055
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License Number State | VA
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