Provider Demographics
NPI:1700899358
Name:SKINNER, WILLIAM E (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:SKINNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5525 MEREDITH DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-2334
Mailing Address - Country:US
Mailing Address - Phone:515-278-2888
Mailing Address - Fax:515-253-9774
Practice Address - Street 1:5525 MEREDITH DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-2334
Practice Address - Country:US
Practice Address - Phone:515-278-2888
Practice Address - Fax:515-253-9774
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA79131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1433755Medicaid