Provider Demographics
NPI:1376626986
Name:SKELTON, SARA ANNE (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ANNE
Last Name:SKELTON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3425 N HENDERSON WAY
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8600
Mailing Address - Country:US
Mailing Address - Phone:931-552-3701
Mailing Address - Fax:931-552-3701
Practice Address - Street 1:4761 ANDREW JACKSON PKWY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-1354
Practice Address - Country:US
Practice Address - Phone:615-885-3525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDH5978124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist