Provider Demographics
NPI:1932485430
Name:SKINNER, DEL D (RDH)
Entity Type:Individual
Prefix:
First Name:DEL
Middle Name:D
Last Name:SKINNER
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 158
Mailing Address - Street 2:538 N. PASEO DE ONATE
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-0158
Mailing Address - Country:US
Mailing Address - Phone:505-753-7218
Mailing Address - Fax:505-753-5815
Practice Address - Street 1:608-B LA JOYA ST
Practice Address - Street 2:EL CENTRO FAMILY HEALTH ESPANOLA DENTAL
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-3467
Practice Address - Country:US
Practice Address - Phone:505-753-9454
Practice Address - Fax:505-753-0850
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH2481124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist