Provider Demographics
NPI:1922163450
Name:SKINNER, RICHARD J (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8605458001 JOHN DEMPSEY HOSPITAL
Mailing Address - Street 2:263 FARMINGTON AVENUE, MC-1610
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-0001
Mailing Address - Country:US
Mailing Address - Phone:860-545-9032
Mailing Address - Fax:860-545-8001
Practice Address - Street 1:JOHN DEMPSEY HOSPITAL
Practice Address - Street 2:263 FARMINGTON AVENUE, MC-1610
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-0001
Practice Address - Country:US
Practice Address - Phone:860-545-9032
Practice Address - Fax:860-545-8001
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0054391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry