Provider Demographics
NPI:1598970519
Name:SKANE, TIMOTHY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:SKANE
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 1:36 S CHARLES ST
Mailing Address - Street 2:SUITE 1405
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-3020
Mailing Address - Country:US
Mailing Address - Phone:410-637-3636
Mailing Address - Fax:410-637-8252
Practice Address - Street 1:36 S CHARLES ST
Practice Address - Street 2:SUITE 1405
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-3020
Practice Address - Country:US
Practice Address - Phone:410-637-3636
Practice Address - Fax:410-637-8252
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD133501223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics