| NPI | 1538557640 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHUCK SKINNER Owner 907-350-3815 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 10514) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 10093) |
| Enumeration Date | 2014-12-26 |
| Last Update Date | 2014-12-26 |