Provider Demographics
NPI:1508948225
Name:SYDOW, DAVID W (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:SYDOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 WOODFERN PLACE
Mailing Address - Street 2:
Mailing Address - City:BRIMFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:61517-9406
Mailing Address - Country:US
Mailing Address - Phone:309-446-9254
Mailing Address - Fax:
Practice Address - Street 1:101 S ROSE STREET
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529-0718
Practice Address - Country:US
Practice Address - Phone:309-742-2071
Practice Address - Fax:309-742-8384
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice