Provider Demographics
NPI:1821553256
Name:SKANDA DENTAL PA
Entity Type:Organization
Organization Name:SKANDA DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSTD
Authorized Official - Prefix:DR
Authorized Official - First Name:SOWMYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-446-3634
Mailing Address - Street 1:2070 US HIGHWAY 1 STE 101
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3745
Mailing Address - Country:US
Mailing Address - Phone:321-631-4334
Mailing Address - Fax:
Practice Address - Street 1:2070 US HIGHWAY 1 STE 101
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3745
Practice Address - Country:US
Practice Address - Phone:321-631-4334
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental