Provider Demographics
NPI:1598865479
Name:CHEESMAN, SKIPPER CURTIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:SKIPPER
Middle Name:CURTIS
Last Name:CHEESMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4649 HICKORY WOOD ROW
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-7450
Mailing Address - Country:US
Mailing Address - Phone:317-422-8818
Mailing Address - Fax:
Practice Address - Street 1:150 N INDIANA ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1506
Practice Address - Country:US
Practice Address - Phone:317-831-4240
Practice Address - Fax:317-831-4473
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120094591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200209740AMedicaid