Provider Demographics
NPI:1073369278
Name:SKOE, SELA ROSE (DDS)
Entity type:Individual
Prefix:DR
First Name:SELA
Middle Name:ROSE
Last Name:SKOE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SELA
Other - Middle Name:ROSE
Other - Last Name:FADNESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:11711 W BURLEIGH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3196
Mailing Address - Country:US
Mailing Address - Phone:414-771-2345
Mailing Address - Fax:
Practice Address - Street 1:2340 DUCK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-3300
Practice Address - Country:US
Practice Address - Phone:920-965-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI60017001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty