Provider Demographics
NPI:1710995089
Name:SKINNER, STEPHANIE L (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:SKINNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10515 WHITE BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-5642
Mailing Address - Country:US
Mailing Address - Phone:912-925-6613
Mailing Address - Fax:912-925-6657
Practice Address - Street 1:10515 WHITE BLUFF RD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-5642
Practice Address - Country:US
Practice Address - Phone:912-925-6613
Practice Address - Fax:912-925-6657
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA115931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice