MEDICARE: JAMES C SKOGNES DMD

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	1223D0001X	Public Health Dentistry	DN012603	GA

General Provider Information

NPI Number	:	1154388726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES C SKOGNES DMD

Provider Business Mailing Address
First Line	:	PO BOX 897
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-0897
Country	:	US
Telephone Number	:	770-339-4283
Fax Number	:	770-963-6322

Provider Business Practice Location Address
First Line	:	5030 GEORGIA BELLE CT
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30093-2667
Country	:	US
Telephone Number	:	770-638-5708
Fax Number	:

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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