Provider Demographics
NPI:1336145929
Name:SKARE, JON DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:DAVID
Last Name:SKARE
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 1:4355 NICOLS RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-1912
Mailing Address - Country:US
Mailing Address - Phone:952-431-5088
Mailing Address - Fax:
Practice Address - Street 1:4355 NICOLS RD
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-1912
Practice Address - Country:US
Practice Address - Phone:952-431-5088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-28
Last Update Date:2014-07-10
Deactivation Date:2006-03-31
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
MN97421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice