MEDICARE: MARK T SKELTON DMD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1093665135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK T SKELTON DMD PC

Provider Business Mailing Address
First Line	:	2101 GRAND AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3541
Country	:	US
Telephone Number	:	256-845-9899
Fax Number	:	256-845-9919

Provider Business Practice Location Address
First Line	:	2101 GRAND AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3541
Country	:	US
Telephone Number	:	256-845-9899
Fax Number	:	256-845-9919

Authorized Official
Title or Position	:	DENTIST
Name	:	MARK SKELTON
Credential	:	DMD
Telephone Number	:	256-845-9899

Provider Enumeration Date	:	01/29/2026
Last Update Date	:	01/29/2026

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