Provider Demographics
NPI:1134412257
Name:K BEN SKERBACK
Entity type:Organization
Organization Name:K BEN SKERBACK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:BENEDICT
Authorized Official - Last Name:SKERBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS PS
Authorized Official - Phone:360-452-3808
Mailing Address - Street 1:218 SO LAUREL
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362
Mailing Address - Country:US
Mailing Address - Phone:360-452-3808
Mailing Address - Fax:360-452-6887
Practice Address - Street 1:218 SO LAUREL
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362
Practice Address - Country:US
Practice Address - Phone:360-452-3808
Practice Address - Fax:360-452-6887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:K BEN SKERBACK DDS PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADL6393122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty