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Individual

DR. DEREK JOHN SKOUSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
59 DG-AF POSTGRADUATE DENTAL SCHOOL, 2133 PEPPERRELL STREET, BUILDING 3352, JBSA-LACKLAND, TX 78236-5313
(210) 292-6258
Mailing address
8218 LINDEMAN PASS, SAN ANTONIO, TX 78254-2286
(415) 980-9336

Taxonomy

Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D011512
AZ

Other

Enumeration date
04/12/2022
Last updated
07/23/2025
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