Basic Information
| Provider Information | |||||||||
| NPI: | 1922163450 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SKINNER | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | J. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8605458001 JOHN DEMPSEY HOSPITAL | ||||||||
| Address2: | 263 FARMINGTON AVENUE, MC-1610 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605459032 | ||||||||
| FaxNumber: | 8605458001 | ||||||||
| Practice Location | |||||||||
| Address1: | JOHN DEMPSEY HOSPITAL | ||||||||
| Address2: | 263 FARMINGTON AVENUE, MC-1610 | ||||||||
| City: | FARMINGTON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605459032 | ||||||||
| FaxNumber: | 8605458001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0221X | 005439 | CT | Y | Dental Providers | Dentist | Pediatric Dentistry |
No ID Information.