Provider Demographics
NPI:1164676235
Name:SIKORA, GREGORY STEPHEN (DMD, MBA)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:SIKORA
Suffix:
Gender:M
Credentials:DMD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E GUADALUPE RD
Mailing Address - Street 2:UNIT 139
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-4588
Mailing Address - Country:US
Mailing Address - Phone:602-849-8587
Mailing Address - Fax:
Practice Address - Street 1:STATE HWY 264
Practice Address - Street 2:MILE MARKER 388
Practice Address - City:POLACCA
Practice Address - State:AZ
Practice Address - Zip Code:86042
Practice Address - Country:US
Practice Address - Phone:928-737-6165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-15
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD7680122300000X
AZD7680 13011379-M1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223D0004XDental ProvidersDentistDentist Anesthesiologist