Provider Demographics
NPI:1255608378
Name:SKELLY, ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SKELLY
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 1:2771 GERYVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:PENNSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18073
Mailing Address - Country:US
Mailing Address - Phone:215-679-4495
Mailing Address - Fax:
Practice Address - Street 1:2771 GERYVILLE PIKE
Practice Address - Street 2:
Practice Address - City:PENNSBURG
Practice Address - State:PA
Practice Address - Zip Code:18073-2306
Practice Address - Country:US
Practice Address - Phone:215-679-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0389091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice