Provider Demographics
NPI:1376612200
Name:SKYLINE FAMILY DENTAL CARE PC
Entity Type:Organization
Organization Name:SKYLINE FAMILY DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:SALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-666-0576
Mailing Address - Street 1:3977 BURMA ROAD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693
Mailing Address - Country:US
Mailing Address - Phone:251-666-0576
Mailing Address - Fax:251-666-0571
Practice Address - Street 1:3977 BURMA ROAD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693
Practice Address - Country:US
Practice Address - Phone:251-666-0576
Practice Address - Fax:251-666-0571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ481Medicare ID - Type Unspecified