Provider Demographics
NPI:1598143422
Name:SKUBAK, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SKUBAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:369 BUTLER ST
Mailing Address - Street 2:
Mailing Address - City:ETNA
Mailing Address - State:PA
Mailing Address - Zip Code:15223-2124
Mailing Address - Country:US
Mailing Address - Phone:412-889-1286
Mailing Address - Fax:
Practice Address - Street 1:369 BUTLER ST
Practice Address - Street 2:
Practice Address - City:ETNA
Practice Address - State:PA
Practice Address - Zip Code:15223-2124
Practice Address - Country:US
Practice Address - Phone:412-889-1286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0404881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice