Provider Demographics
NPI:1275189516
Name:SYKORA, GREGORY JAMES (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:JAMES
Last Name:SYKORA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1476 SW STUMP ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-2454
Mailing Address - Country:US
Mailing Address - Phone:541-550-0053
Mailing Address - Fax:
Practice Address - Street 1:1830 NW 9TH ST STE 106
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2368
Practice Address - Country:US
Practice Address - Phone:541-207-0603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD11128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist