Healthcare Provider Details

I. General information

NPI: 1285554006
Provider Name (Legal Business Name): GRANT THOMAS SISK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 5TH AVE
HYNDMAN PA
15545-7379
US

IV. Provider business mailing address

266 EDDY DR
HYNDMAN PA
15545-7701
US

V. Phone/Fax

Practice location:
  • Phone: 814-842-3206
  • Fax:
Mailing address:
  • Phone: 814-585-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS045909
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: