Provider Demographics
NPI:1033227236
Name:SKAGGS, BARRY JASON (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:JASON
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9201 SUNSET BLVD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90069
Mailing Address - Country:US
Mailing Address - Phone:310-275-3635
Mailing Address - Fax:310-275-3646
Practice Address - Street 1:9201 SUNSET BLVD
Practice Address - Street 2:SUITE 502
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069
Practice Address - Country:US
Practice Address - Phone:310-275-3635
Practice Address - Fax:310-275-3646
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA0333761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery