Provider Demographics
NPI:1811310626
Name:DR. ROBERT SKILES PLLC
Entity type:Organization
Organization Name:DR. ROBERT SKILES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:AUNDRA
Authorized Official - Last Name:SKILES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-635-5004
Mailing Address - Street 1:1500 POPLAR LEVEL RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1316
Mailing Address - Country:US
Mailing Address - Phone:502-635-5004
Mailing Address - Fax:502-719-6286
Practice Address - Street 1:1500 POPLAR LEVEL RD
Practice Address - Street 2:SUITE 3
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1316
Practice Address - Country:US
Practice Address - Phone:502-635-5004
Practice Address - Fax:502-719-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5072302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization