Provider Demographics
NPI:1740621036
Name:DON E. SKAFF, DDS, INC.
Entity type:Organization
Organization Name:DON E. SKAFF, DDS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:E
Authorized Official - Last Name:SKAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-926-9260
Mailing Address - Street 1:4502 MACCORKLE AVE SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1835
Mailing Address - Country:US
Mailing Address - Phone:304-926-9260
Mailing Address - Fax:304-926-9266
Practice Address - Street 1:4502 MACCORKLE AVE SE
Practice Address - Street 2:SUITE C
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1835
Practice Address - Country:US
Practice Address - Phone:304-926-9260
Practice Address - Fax:304-926-9266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0138545000Medicaid