Provider Demographics
NPI:1689770067
Name:DR. BILL SKINNER
Entity Type:Organization
Organization Name:DR. BILL SKINNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOODRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-755-3626
Mailing Address - Street 1:611 E MAIN ST
Mailing Address - Street 2:PO BOX 274
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-1097
Mailing Address - Country:US
Mailing Address - Phone:641-755-3626
Mailing Address - Fax:641-755-3699
Practice Address - Street 1:611 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PANORA
Practice Address - State:IA
Practice Address - Zip Code:50216-1097
Practice Address - Country:US
Practice Address - Phone:641-755-3626
Practice Address - Fax:641-755-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0433755Medicaid