Provider Demographics
NPI:1205042801
Name:SKIPWORTH, STEPHEN GARTH
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GARTH
Last Name:SKIPWORTH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22550 SKYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9676
Mailing Address - Country:US
Mailing Address - Phone:541-383-1522
Mailing Address - Fax:
Practice Address - Street 1:22550 SKYVIEW LN
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-9676
Practice Address - Country:US
Practice Address - Phone:541-383-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR48731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice