Provider Demographics
NPI:1639669815
Name:SKARDA, KATIE SHERIDAN (DDS)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:SHERIDAN
Last Name:SKARDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:JEAN
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12205 GAYTON RD STE A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3212
Mailing Address - Country:US
Mailing Address - Phone:804-741-1400
Mailing Address - Fax:
Practice Address - Street 1:12205 GAYTON RD STE A
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23238-3212
Practice Address - Country:US
Practice Address - Phone:804-741-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1639669815122300000X
390200000X
VA04014164781223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program