Provider Demographics
NPI:1619389350
Name:PEACOCK, SKYLER ROBIN (DMD)
Entity Type:Individual
Prefix:
First Name:SKYLER
Middle Name:ROBIN
Last Name:PEACOCK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9060 HARMONY DR STE D
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-6253
Mailing Address - Country:US
Mailing Address - Phone:405-737-8831
Mailing Address - Fax:405-458-8022
Practice Address - Street 1:9060 HARMONY DR STE D
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-6253
Practice Address - Country:US
Practice Address - Phone:405-737-8831
Practice Address - Fax:405-458-8022
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice