Provider Demographics
NPI:1730675588
Name:SKAGGS, DANIEL RYAN
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:RYAN
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 1:4709 OAK POINTE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-6439
Mailing Address - Country:US
Mailing Address - Phone:561-601-9035
Mailing Address - Fax:
Practice Address - Street 1:111 HERITAGE SQ
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1863
Practice Address - Country:US
Practice Address - Phone:812-248-4880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00203667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty