Healthcare Provider Details

I. General information

NPI: 1609653088
Provider Name (Legal Business Name): MICHAEL SYCHRAVA DMD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 OLYMPIC BLVD STE 360
WALNUT CREEK CA
94596-5069
US

IV. Provider business mailing address

11 HAMPTON CT
ALAMEDA CA
94502-6436
US

V. Phone/Fax

Practice location:
  • Phone: 925-465-1200
  • Fax: 925-465-1250
Mailing address:
  • Phone: 909-660-1337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL SYCHRAVA
Title or Position: CEO
Credential: DMD
Phone: 925-465-1200