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General NPI Number Information
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NPI Number | 1275189516
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Entity Type | Individual
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Provider Name | GREGORY JAMES SYKORA DMD
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Gender | Male
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 1830 NW 9TH ST STE 106
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City | CORVALLIS
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State | OR
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Zip | 97330-2368
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Country | US
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Telephone | 541-207-0603
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Fax |
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Provider Business Mailing Address
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Address Line | 1476 SW STUMP ST
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City | DALLAS
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State | OR
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Zip | 97338-2454
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Country | US
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Telephone | 541-550-0053
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D11128
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License Number State | OR
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