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General NPI Number Information
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NPI Number | 1922422633
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Entity Type | Organization
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Legal Business Name | FOUNTAIN DENTAL CENTER P.C.
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 02/17/2014
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Provider Practice Location Address
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Address Line | 8085 FOUNTAIN MESA RD
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City | FOUNTAIN
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State | CO
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Zip | 80817-1591
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Country | US
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Telephone | 719-382-5500
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Fax | 719-382-0944
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Provider Business Mailing Address
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Address Line | 8085 FOUNTAIN MESA RD
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City | FOUNTAIN
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State | CO
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Zip | 80817-1591
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Country | US
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Telephone | 719-382-5500
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Fax | 719-382-0944
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Authorized Official
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Title or Position | OWNER
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Name | DR. KENDALL B SKINNER
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Credential | DDS
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Telephone | 719-382-5500
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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 | 10691
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License Number State | CO
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