Provider Demographics
NPI:1215181383
Name:SKUBEN, PETER (DDS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:SKUBEN
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 1:145 E 19TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-2877
Mailing Address - Country:US
Mailing Address - Phone:949-650-1414
Mailing Address - Fax:949-891-0409
Practice Address - Street 1:145 E 19TH ST STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2877
Practice Address - Country:US
Practice Address - Phone:949-650-1414
Practice Address - Fax:949-891-0409
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-15
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57867122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist