Provider Demographics
NPI:1326160060
Name:THE DENTAL PRACTICE OF JOHN R. SISK,D.D.S. INC.
Entity Type:Organization
Organization Name:THE DENTAL PRACTICE OF JOHN R. SISK,D.D.S. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:SISK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-948-8154
Mailing Address - Street 1:2606 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47129-1642
Mailing Address - Country:US
Mailing Address - Phone:812-944-9055
Mailing Address - Fax:
Practice Address - Street 1:601 E SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2923
Practice Address - Country:US
Practice Address - Phone:812-948-8154
Practice Address - Fax:812-948-8163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006801A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty