Provider Demographics
NPI:1235351495
Name:SKUR, ODALIS P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ODALIS
Middle Name:P
Last Name:SKUR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ODALIS
Other - Middle Name:P
Other - Last Name:SKUR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:779 EAST FM HWY 1187
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036
Mailing Address - Country:US
Mailing Address - Phone:817-297-0058
Mailing Address - Fax:817-297-7811
Practice Address - Street 1:779 EAST FM 1187
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036
Practice Address - Country:US
Practice Address - Phone:817-297-0058
Practice Address - Fax:214-297-7811
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159565401Medicaid
TX20899OtherCHIP NUMBER