MEDICARE: DR. AIMEE S SKELTON D.M.D., M.S., P.C.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	4879	AL

General Provider Information

NPI Number	:	1346437613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AIMEE S SKELTON D.M.D., M.S., P.C.

Provider Business Mailing Address
First Line	:	2105 GRAND AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3541
Country	:	US
Telephone Number	:	256-844-8221
Fax Number	:	256-844-8228

Provider Business Practice Location Address
First Line	:	2105 GRAND AVE NW
Second Line	:
City	:	FORT PAYNE
State	:	AL
Zip	:	35967-3541
Country	:	US
Telephone Number	:	256-844-8221
Fax Number	:	256-844-8228

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

Provider Enumeration Date	:	10/01/2007
Last Update Date	:	10/01/2007

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