Healthcare Provider Details

I. General information

NPI: 1558045310
Provider Name (Legal Business Name): JALEN CONNOR SYKES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 MCBROOM ST NW STE C
ABINGDON VA
24210-2590
US

IV. Provider business mailing address

699 MCBROOM ST NW STE C
ABINGDON VA
24210-2590
US

V. Phone/Fax

Practice location:
  • Phone: 276-628-6251
  • Fax:
Mailing address:
  • Phone: 276-628-6251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401418496
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: