Provider Demographics
NPI:1518735075
Name:MILLER SKINNER DASTRUP AND BOGLE DENTAL CORPORATION OF CLORIS
Entity Type:Organization
Organization Name:MILLER SKINNER DASTRUP AND BOGLE DENTAL CORPORATION OF CLORIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-399-3588
Mailing Address - Street 1:290 SHAW AVE, STE. #C
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612
Mailing Address - Country:US
Mailing Address - Phone:559-298-3024
Mailing Address - Fax:559-298-3026
Practice Address - Street 1:290 SHAW AVE, STE. #C
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612
Practice Address - Country:US
Practice Address - Phone:559-298-3024
Practice Address - Fax:559-298-3026
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILLER SKINNER DASTRUP AND BOGLE DENTAL CORPORATION OF CLORIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty