Healthcare Provider Details

I. General information

NPI: 1164688180
Provider Name (Legal Business Name): O T SYKES D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 AIRWAYS BLVD SUITE 6
MEMPHIS TN
38114-6604
US

IV. Provider business mailing address

1399 AIRWAYS BLVD STE 6
MEMPHIS TN
38114-6604
US

V. Phone/Fax

Practice location:
  • Phone: 901-323-7613
  • Fax: 901-323-7614
Mailing address:
  • Phone: 901-323-7613
  • Fax: 901-323-7614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS2175
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: