Provider Demographics
NPI:1164749933
Name:SKINNER, JEREMY DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:DANIEL
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 FARMLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-9131
Mailing Address - Country:US
Mailing Address - Phone:480-399-3588
Mailing Address - Fax:
Practice Address - Street 1:552 W 26TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2837
Practice Address - Country:US
Practice Address - Phone:480-399-3588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD77551223G0001X
CA1002361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice