Provider Demographics
NPI:1730675588
Name:SKAGGS, DANIEL RYAN
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:RYAN
Last Name:SKAGGS
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 1:3755 BRIARGATE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4194
Mailing Address - Country:US
Mailing Address - Phone:719-434-5800
Mailing Address - Fax:
Practice Address - Street 1:3755 BRIARGATE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4194
Practice Address - Country:US
Practice Address - Phone:719-434-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-05
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN00203667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty