Healthcare Provider Details

I. General information

NPI: 1366501819
Provider Name (Legal Business Name): JOHN C SYKES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2647 BULVERDE RD
BULVERDE TX
78163-2105
US

IV. Provider business mailing address

2647 BULVERDE RD
BULVERDE TX
78163-2105
US

V. Phone/Fax

Practice location:
  • Phone: 830-980-9004
  • Fax: 830-980-2248
Mailing address:
  • Phone: 830-980-9004
  • Fax: 830-980-2248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20512
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: