Provider Demographics
NPI:1346975851
Name:SKAF, REBECCA
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:SKAF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PENN AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2157
Mailing Address - Country:US
Mailing Address - Phone:610-375-3366
Mailing Address - Fax:610-375-6791
Practice Address - Street 1:1500 PENN AVE STE 2
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2157
Practice Address - Country:US
Practice Address - Phone:610-375-3366
Practice Address - Fax:610-375-6791
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS043801122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist