MEDICARE: DR. DANIEL W SKINNER, P.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	261QS0112X	Oral and Maxillofacial Surgery Clinic/Center	DE00004749	WA

General Provider Information

NPI Number	:	1811083793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DANIEL W SKINNER, P.S.

Provider Business Mailing Address
First Line	:	12509 E MISSION AVE
Second Line	:	SUITE 101
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1049
Country	:	US
Telephone Number	:	509-928-3600
Fax Number	:	509-922-7244

Provider Business Practice Location Address
First Line	:	12509 E MISSION AVE
Second Line	:	SUITE 101
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99216-1049
Country	:	US
Telephone Number	:	509-928-3600
Fax Number	:	509-922-7244

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANIEL W SKINNER
Credential	:	DDS, MS
Telephone Number	:	509-928-3600

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	08/16/2023

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