Provider Demographics
NPI:1326421769
Name:SKACHKOV, EDUARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDUARD
Middle Name:
Last Name:SKACHKOV
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 1:8933 MARKET PL
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-4909
Mailing Address - Country:US
Mailing Address - Phone:425-334-5085
Mailing Address - Fax:
Practice Address - Street 1:8933 MARKET PL
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-4909
Practice Address - Country:US
Practice Address - Phone:425-334-5085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE605694561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice