Healthcare Provider Details

I. General information

NPI: 1275189516
Provider Name (Legal Business Name): GREGORY JAMES SYKORA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 NW 9TH ST STE 106
CORVALLIS OR
97330-2368
US

IV. Provider business mailing address

1476 SW STUMP ST
DALLAS OR
97338-2454
US

V. Phone/Fax

Practice location:
  • Phone: 541-207-0603
  • Fax:
Mailing address:
  • Phone: 541-550-0053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD11128
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: