Provider Demographics
NPI:1639320138
Name:DANIEL D SKOTZKO DDS PA
Entity Type:Organization
Organization Name:DANIEL D SKOTZKO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SKOTZKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-987-8700
Mailing Address - Street 1:20816 N MAIN ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8468
Mailing Address - Country:US
Mailing Address - Phone:704-987-8700
Mailing Address - Fax:
Practice Address - Street 1:20816 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8468
Practice Address - Country:US
Practice Address - Phone:704-987-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC6536261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental