Provider Demographics
NPI:1740413830
Name:SKINNER OSSAKOW & ASSOCIATES
Entity Type:Organization
Organization Name:SKINNER OSSAKOW & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEROSIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-858-9067
Mailing Address - Street 1:44125 WOODRIDGE PKWY STE 160
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-6839
Mailing Address - Country:US
Mailing Address - Phone:703-858-9067
Mailing Address - Fax:703-858-9267
Practice Address - Street 1:44125 WOODRIDGE PKWY STE 160
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-6839
Practice Address - Country:US
Practice Address - Phone:703-858-9067
Practice Address - Fax:703-858-9267
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKINNER OSSAKOW & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty