Provider Demographics
NPI:1740319037
Name:SKAGGS, DAN E (DDS)
Entity type:Individual
Prefix:DR
First Name:DAN
Middle Name:E
Last Name:SKAGGS
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 1:1845 EASTWEST PKWY
Mailing Address - Street 2:SUITE 3 & 4
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32003-6405
Mailing Address - Country:US
Mailing Address - Phone:904-278-7308
Mailing Address - Fax:
Practice Address - Street 1:1845 EASTWEST PKWY
Practice Address - Street 2:SUITE 3 & 4
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32003-6405
Practice Address - Country:US
Practice Address - Phone:904-278-7308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00140911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice