Provider Demographics
NPI:1497858369
Name:SKEENS, GREGORY WAYNE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WAYNE
Last Name:SKEENS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:519 ENCINITAS BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3738
Mailing Address - Country:US
Mailing Address - Phone:760-944-9288
Mailing Address - Fax:760-944-3461
Practice Address - Street 1:519 ENCINITAS BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3738
Practice Address - Country:US
Practice Address - Phone:760-944-9288
Practice Address - Fax:760-944-3461
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice