Provider Demographics
NPI:1003902990
Name:SKINNER, DANIEL W (DDS, MS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12509 E MISSION AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1049
Mailing Address - Country:US
Mailing Address - Phone:509-928-3600
Mailing Address - Fax:509-922-7244
Practice Address - Street 1:12509 E MISSION AVE
Practice Address - Street 2:STE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1049
Practice Address - Country:US
Practice Address - Phone:509-928-3600
Practice Address - Fax:509-922-7244
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000079111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA132958OtherL&I
WA8926698OtherVICTIMS OF CRIME
WA5026224Medicaid
WA57911OtherWDS
WA5026224Medicaid
WA190008828Medicare ID - Type UnspecifiedRAILROAD MEDICARE