DR. JOHN STEVEN SKUPAS DDS, NPI 1710063177 — CUMBERLAND (MD)

NPI 1710063177

13+ Years Experience Individual

DR. JOHN STEVEN SKUPAS DDS

10/28/2006
PROVIDER ENUMERATION DATE
07.08.2007
LAST UPDATE DATE
1710063177
NPI NUMBER

About DR. JOHN STEVEN SKUPAS

Sole proprietor? No, Entity Type 1 Provider (Individual) is not a Sole Proprietor.

DR. JOHN STEVEN SKUPAS is a provider established in CUMBERLAND, MD. The NPI number of DR. JOHN STEVEN SKUPAS is 1710063177 and was assigned on 10/28/2006. The practitioners primary taxonomy code is: 122300000X with license number: 5028 MD .

Mailing address

  • City: CUMBERLAND
  • State: MD
  • Postal code: 21502
  • Phone: 3017226688
  • Address: 418 N MECHANIC STREET
  • Address 2: APT A

Primary Practice Address

  • Region : CUMBERLAND, MD
  • NPI : 1710063177
  • Phone : 3017226688
  • Fax : 3017220712
  • Postalcode : 21502
  • Address : 418 N MECHANIC STREET APT A

Additional identifiers

  • Identifier: 217457
  • Code / Type : 1 - other
  • Identifier state :
  • Identifier issuer: TRIGON BLUE SHIELD

Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Additional identifiers # 2

  • Identifier: 7670
  • Code / Type : 1 - other
  • Identifier issuer : DENTAL NETWORK

Provider taxonomy - Dentist

  • Taxonomy code: 122300000X
  • License number: 5028
  • License state: MD

The taxonomy is the primary taxonomy (there can be only one per NPI record).

Taxonomy description: A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association"s Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

Contacts:

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  • DR. JOHN STEVEN SKUPAS DDS
  • Address : 418 N MECHANIC STREET APT A
  • Region : CUMBERLAND, MD
  • NPI : 1710063177
  • Phone : 3017226688
  • Fax : 3017220712
  • Postalcode : 21502

Reference NPI Information. Full replica of the CMS (NPPES) NPI record

Field Name Value
Provider First Line Business Practice Location Address418 N MECHANIC STREET
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressAPT A
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameCUMBERLAND
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMD
The State or Province name in the location address of the provider being identified.
Provider Business Practice Location Address Postal Code21502
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Telephone Number3017226688
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3017220712
The fax number associated with the location address of the provider being identified.
NPI1710063177
10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
Healthcare Provider Taxonomy 1122300000X
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association"s Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Provider Enumeration Date10/28/2006
The date the provider was assigned a unique identifier (assigned an NPI).
Last Updated07.08.2007
The date that a record was last updated or changed.
Entity TypeIndividual
Code describing the type of health care provider that is being assigned an NPI. Codes are:
  • 1 = (Person): individual human being who furnishes health care;
  • 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Provider Organization Name (Legal Business Name)DR. JOHN STEVEN SKUPAS
Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
Provider First Line Business Mailing Address418 N MECHANIC STREET
The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
Provider Second Line Business Mailing AddressAPT A
The second line mailing address of the provider being identified. This data element may contain the same information as "Provider second line location address".
Provider Business Mailing Address City NameCUMBERLAND
The City name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address City name".
Provider Business Mailing Address State NameMD
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
Provider Business Mailing Address Postal Code21502
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
Provider Business Mailing Address Telephone Number3017226688
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as "Provider location address telephone number".
Healthcare Provider Taxonomy Code #1122300000X
The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
Healthcare Provider Taxonomy 1Dentist
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association"s Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Provider License Number 15028
Certain taxonomy selections will require you to enter your license number and the state where the license was issued. Select Foreign Country in the state drop down box if the license was issued outside of United States. The License Number field allows the following special characters: ampersand, apostrophe, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters. DO NOT report the Social Security Number (SSN), IRS Individual Taxpayer Identification Number (ITIN) in this section.
Provider License Number State Code 1MD
Healthcare Provider Primary Taxonomy Switch 1Y
Primary Taxonomy:
  • X - The primary taxonomy switch is Not Answered;
  • Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
  • N - The taxonomy is not the primary taxonomy.
Other Provider Identifier 1217457
Other Provider Identifier #1
Other Provider Identifier Type 11
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier Issuer 1TRIGON BLUE SHIELD
Other Provider Identifier Issuer #1
Other Provider Identifier 27670
Other Provider Identifier #2
Other Provider Identifier Type 21
  • 1 - Other
  • 5 - MEDICAID
Other Provider Identifier Issuer 2DENTAL NETWORK
Other Provider Identifier Issuer #2
Provider Gender CodeM
  • M - male
  • F - female
Is sole proprietorN
  • X - Not Answered
  • Y - Yes, Entity Type 1 Provider (Individual) is a Sole Proprietor
  • N - No, Entity Type 1 Provider (Individual) is not a Sole Proprietor
X

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