Provider Demographics
NPI:1710063177
Name:SKUPAS, JOHN STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEVEN
Last Name:SKUPAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N MECHANIC STREET
Mailing Address - Street 2:APT A
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502
Mailing Address - Country:US
Mailing Address - Phone:301-722-6688
Mailing Address - Fax:
Practice Address - Street 1:418 N MECHANIC STREET
Practice Address - Street 2:APT A
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502
Practice Address - Country:US
Practice Address - Phone:301-722-6688
Practice Address - Fax:301-722-0712
Is Sole Proprietor?:No
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5901OtherCAREFIRST
7670OtherDENTAL NETWORK
406OtherDOMINION DENTAL
217457OtherTRIGON BLUE SHIELD
36201OtherDENTAL BENEFIT PROVIDERS