Provider Demographics
NPI:1811083793
Name:DR. DANIEL W SKINNER, P.S.
Entity type:Organization
Organization Name:DR. DANIEL W SKINNER, P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:509-928-3600
Mailing Address - Street 1:12509 E MISSION AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1049
Mailing Address - Country:US
Mailing Address - Phone:509-928-3600
Mailing Address - Fax:509-922-7244
Practice Address - Street 1:12509 E MISSION AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1049
Practice Address - Country:US
Practice Address - Phone:509-928-3600
Practice Address - Fax:509-922-7244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00004749261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5000302Medicaid
WA8901524OtherVICTIMS OF CRIME
WA131589131589OtherPREMERA BLUE CROSS
WA8901524OtherVICTIMS OF CRIME