Provider Demographics
NPI:1710061544
Name:SKAGGS, ERNEST O
Entity Type:Individual
Prefix:
First Name:ERNEST
Middle Name:O
Last Name:SKAGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-3301
Mailing Address - Country:US
Mailing Address - Phone:270-351-3265
Mailing Address - Fax:270-357-3557
Practice Address - Street 1:555 W LINCOLN TRAIL BLVD
Practice Address - Street 2:SUITE 25
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-3301
Practice Address - Country:US
Practice Address - Phone:270-351-3265
Practice Address - Fax:270-357-3557
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice