Provider Demographics
NPI:1164814596
Name:ANDREW L. SKIGEN DMD PA
Entity Type:Organization
Organization Name:ANDREW L. SKIGEN DMD PA
Other - Org Name:FIRST COAST ORAL & MAXILLOFACIAL SURGERY
Other - Org Type:Other Name
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:L
Authorized Official - Last Name:SKIGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-565-1505
Mailing Address - Street 1:8708 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1107
Mailing Address - Country:US
Mailing Address - Phone:904-565-1505
Mailing Address - Fax:904-565-1506
Practice Address - Street 1:8708 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6354
Practice Address - Country:US
Practice Address - Phone:904-565-1505
Practice Address - Fax:904-565-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-23
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14048204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty