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General NPI Number Information
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NPI Number | 1851882971
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Entity Type | Organization
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Legal Business Name | SKINNERCHUDLEIGH DMD LLC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 1760 CENTENNIAL DR
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City | LOUISVILLE
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State | CO
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Zip | 80027-1302
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Country | US
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Telephone | 303-665-7505
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Fax |
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Provider Business Mailing Address
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Address Line | 1760 CENTENNIAL DR
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City | LOUISVILLE
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State | CO
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Zip | 80027-1302
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Country | US
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Telephone | 303-665-7505
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | CHUCK SKINNER
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Credential | DMD
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Telephone | 303-665-7505
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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 | 201865
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 104857
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 10514
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License Number State | CO
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