Provider Demographics
NPI:1164752606
Name:SKASKO, ANDREW EMIL (DDS)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:EMIL
Last Name:SKASKO
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 1:5101 FOREST DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8215
Mailing Address - Country:US
Mailing Address - Phone:614-939-0400
Mailing Address - Fax:614-939-0404
Practice Address - Street 1:5101 FOREST DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-8215
Practice Address - Country:US
Practice Address - Phone:614-939-0400
Practice Address - Fax:614-939-0404
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-06
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH219071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice