MEDICARE: ROBERT L SKINNER DDS PA

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	1223G0001X	General Practice Dentistry	2752	AR

General Provider Information

NPI Number	:	1962422204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L SKINNER DDS PA

Provider Business Mailing Address
First Line	:	2414 S 58TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3827
Country	:	US
Telephone Number	:	479-452-3368
Fax Number	:	479-452-3316

Provider Business Practice Location Address
First Line	:	2414 S 58TH ST
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3827
Country	:	US
Telephone Number	:	479-452-3368
Fax Number	:	479-452-3316

Authorized Official
Title or Position	:	OWNER/DENIST
Name	:	DR. ROBERT L SKINNER
Credential	:	DDS
Telephone Number	:	479-452-3368

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	08/22/2020

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