MEDICARE: DR. DAVID KEVIN SKEELS D.D.S.

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	122300000X	Dentist	040915	NY

General Provider Information

NPI Number	:	1134135247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KEVIN SKEELS D.D.S.

Provider Business Mailing Address
First Line	:	1880 RIDGE RD E
Second Line	:	SUITE 1A
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2473
Country	:	US
Telephone Number	:	585-544-2103
Fax Number	:	585-544-2078

Provider Business Practice Location Address
First Line	:	1880 RIDGE RD E
Second Line	:	SUITE 1A
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2473
Country	:	US
Telephone Number	:	585-544-2103
Fax Number	:	585-544-2078

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/08/2007

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