Healthcare Provider Details

I. General information

NPI: 1013420462
Provider Name (Legal Business Name): DR. STEVON RONALD SYKES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA DENTAL HEALTH ACTIVITY BLDG 38801, SUITE B&C
FT GORDON GA
30905-5660
US

IV. Provider business mailing address

680 CRANE CREEK DR APT 1021
AUGUSTA GA
30907-3666
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-6927
  • Fax: 706-787-2082
Mailing address:
  • Phone: 810-531-3253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901022456
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: