Healthcare Provider Details

I. General information

NPI: 1629075460
Provider Name (Legal Business Name): DAVID L SYKES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 MAPLE AVE
LINWOOD NJ
08221-1213
US

IV. Provider business mailing address

524 MAPLE AVE
LINWOOD NJ
08221-1213
US

V. Phone/Fax

Practice location:
  • Phone: 609-653-6300
  • Fax: 609-653-4204
Mailing address:
  • Phone: 609-653-6300
  • Fax: 609-653-4204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD1012389
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: