Provider Demographics
NPI:1215188982
Name:SKUPNY, JEFFREY ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ROBERT
Last Name:SKUPNY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20570 GROVELINE CT
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-3160
Mailing Address - Country:US
Mailing Address - Phone:352-246-3177
Mailing Address - Fax:
Practice Address - Street 1:1044 CASTELLO DR
Practice Address - Street 2:110
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8901
Practice Address - Country:US
Practice Address - Phone:239-261-5566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-30
Last Update Date:2014-09-18
Deactivation Date:2010-12-03
Deactivation Code:
Reactivation Date:2014-09-04
Provider Licenses
StateLicense IDTaxonomies
FLDN18097122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist