Provider Demographics
NPI:1295808491
Name:SKINNER, RAYMOND (MS, DDS)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:SKINNER
Suffix:
Gender:M
Credentials:MS, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1277 E MISSOURI AVE
Mailing Address - Street 2:SUITE, 102
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2915
Mailing Address - Country:US
Mailing Address - Phone:602-266-5896
Mailing Address - Fax:602-274-6114
Practice Address - Street 1:1277 E MISSOURI AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2915
Practice Address - Country:US
Practice Address - Phone:602-266-5896
Practice Address - Fax:602-274-6114
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD19241223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics