Provider Demographics
NPI:1043250236
Name:SKOPP, MARSHALL S (DMD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:S
Last Name:SKOPP
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10303-1737
Mailing Address - Country:US
Mailing Address - Phone:718-982-5230
Mailing Address - Fax:718-982-5231
Practice Address - Street 1:2040 FOREST AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10303-1737
Practice Address - Country:US
Practice Address - Phone:718-982-5230
Practice Address - Fax:718-982-5231
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0452751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice