Provider Demographics
NPI:1003841438
Name:SKUBEN-VADKERTI, JANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:SKUBEN-VADKERTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:ELIZABETH
Other - Last Name:SKUBEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1690 N PLACENTIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5527
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1690 N PLACENTIA AVE STE A
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5527
Practice Address - Country:US
Practice Address - Phone:714-528-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA515211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice