Provider Demographics
NPI:1821156605
Name:SKOGLUND, CHARLES S (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:S
Last Name:SKOGLUND
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 1:513 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-4966
Mailing Address - Country:US
Mailing Address - Phone:402-379-2775
Mailing Address - Fax:402-379-0120
Practice Address - Street 1:513 S 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4966
Practice Address - Country:US
Practice Address - Phone:402-379-2775
Practice Address - Fax:402-379-0120
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice