John Daniel Skipper Jr., DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE60770848 Issued in WA

Practice address

5720 Ruddell Rd SE Ste a&B
Lacey, WA 98503-6401

Phone

(360) 438-0805

NPI assigned

Oct 5, 2017

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

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1507161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1518477447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8012 112TH STREET CT E STE 320",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983737856",
            "telephone_number": "253-848-2331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5720 RUDDELL RD SE STE A&B",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985036401",
            "telephone_number": "360-438-0805"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8012 112th Street Ct E Ste 320",
            "address_purpose": "LOCATION",
            "city": "Puyallup",
            "state": "WA",
            "postal_code": "983737856",
            "country_code": "US",
            "telephone_number": "253-848-2331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKIPPER",
        "first_name": "JOHN",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-05",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE60770848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Dawn Sisk
• Stephanie Sisson, MSW
• Raj Sitapara
• Stormie Gail Skelton
• Lisa Skinner
• Katherine Skipworth
• Karstin Lee Slade, PH.D.
• Kyra L Slater
• Nina L Slavsky, LMP
• Jennifer Slocum

• General Practice Dentistry in Lacey, WA
• Providers in Lacey, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.