Provider Demographics
NPI:1093440208
Name:SKYLINE DENTAL LLC
Entity Type:Organization
Organization Name:SKYLINE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CORIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUMMIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-389-4807
Mailing Address - Street 1:2137 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3824
Mailing Address - Country:US
Mailing Address - Phone:541-389-4807
Mailing Address - Fax:541-389-4807
Practice Address - Street 1:2137 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3824
Practice Address - Country:US
Practice Address - Phone:541-389-4807
Practice Address - Fax:541-389-4807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty