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General NPI Number Information
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NPI Number | 1518597590
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Entity Type | Individual
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Provider Name | PARK SKELTON DMD
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Gender | Male
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Dates
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Enumeration Date | 01/18/2020
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Last Update Date | 06/30/2020
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Provider Practice Location Address
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Address Line | 6410 FANNIN ST STE 310
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City | HOUSTON
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State | TX
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Zip | 77030-3004
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Country | US
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Telephone | 404-435-3318
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Fax |
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Provider Business Mailing Address
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Address Line | 930 DAVIS BND
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City | ALPHARETTA
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State | GA
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Zip | 30004-1158
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Country | US
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Telephone | 404-435-3318
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN015993
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License Number State | GA
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