Provider Demographics
NPI:1174648265
Name:SKELTON, LI LUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LI
Middle Name:LUO
Last Name:SKELTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 BROADWAY ST STE 129
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5901
Mailing Address - Country:US
Mailing Address - Phone:210-824-1880
Mailing Address - Fax:210-824-7918
Practice Address - Street 1:9200 BROADWAY ST STE 129
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5901
Practice Address - Country:US
Practice Address - Phone:210-824-1880
Practice Address - Fax:210-824-7918
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX183681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice