Derek John Skousen, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D011512 Issued in AZ

Practice address

59 DG-Af Postgraduate Dental School
2133 Pepperrell Street, Building 3352
Jbsa-Lackland, TX 78236-5313

Phone

(210) 292-6258

NPI assigned

Apr 12, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1649721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1366184947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8218 LINDEMAN PASS",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782542286",
            "telephone_number": "415-980-9336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "59 DG-AF POSTGRADUATE DENTAL SCHOOL",
            "address_2": "2133 PEPPERRELL STREET, BUILDING 3352",
            "city": "JBSA-LACKLAND",
            "state": "TX",
            "postal_code": "782365313",
            "telephone_number": "210-292-6258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2437 E Minton St",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852131502",
            "country_code": "US",
            "telephone_number": "415-980-9336",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Twining St Bldg 760",
            "address_purpose": "LOCATION",
            "city": "Maxwell AFB",
            "state": "AL",
            "postal_code": "361126027",
            "country_code": "US",
            "telephone_number": "334-953-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKOUSEN",
        "first_name": "DEREK",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-12",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "D011512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Evan Shipp
• Mark Sidransky, DDS
• Steven Siemieniak, DO
• Dustin Simpson, M.D.
• Kathryn C Simpson, MD
• Aileen Smith
• Derek Smith, M.D.
• Allen Kyle Smithson, MS, RD, CSSD, LDN
• Michael T. Smolka, D.O.
• Andrew Norman Snell

• Dentist in Jbsa-Lackland, TX
• Providers in Jbsa-Lackland, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.