Provider Demographics
NPI:1013530153
Name:SKYLAR, TATIANA NICOLE (DMD)
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:NICOLE
Last Name:SKYLAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 MALLARD LN
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-3630
Mailing Address - Country:US
Mailing Address - Phone:847-668-3308
Mailing Address - Fax:
Practice Address - Street 1:125 W TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1424
Practice Address - Country:US
Practice Address - Phone:847-367-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2020-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190325731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice