Provider Demographics
NPI:1477910503
Name:SKANCHY, TONY LEWIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:LEWIS
Last Name:SKANCHY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 W 13400 S
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6410
Mailing Address - Country:US
Mailing Address - Phone:385-210-1111
Mailing Address - Fax:
Practice Address - Street 1:4013 W 13400 S
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6410
Practice Address - Country:US
Practice Address - Phone:385-210-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT870264799211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics