Organization
105 W MADISON DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY SKIDMORE DDS (PRACTICE ADMINISTRATOR)
(630) 816-9064
Entity
Organization
Contact information
Practice address
105 W MADISON ST STE 300, CHICAGO, IL 60602-4602
(561) 899-4595
Mailing address
600 FAIRWAY DR STE 206, DEERFIELD BEACH, FL 33441-1807
(561) 899-4595
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/27/2018
Last updated
06/27/2018
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