Healthcare Provider Details

I. General information

NPI: 1841467586
Provider Name (Legal Business Name): ADAM CRAIG SYDELL D.M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SAULSBURY RD
DOVER DE
19904-3444
US

IV. Provider business mailing address

77 SAULSBURY RD
DOVER DE
19904-3444
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-2942
  • Fax: 302-678-2294
Mailing address:
  • Phone: 302-678-2942
  • Fax: 302-678-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number100123785
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberG1-0001281
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: