Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 4875 | AZ |
NPI | 1013070556 |
---|---|
Provider Name | Cameron Skaugrud |
First Address | Phoenix, AZ 85021-8864 |
Second Address | Phoenix, AZ 85021-8864 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 08/07/2007 |