Provider Demographics
NPI:1609653088
Name:MICHAEL SYCHRAVA DMD INC
Entity Type:Organization
Organization Name:MICHAEL SYCHRAVA DMD INC
Other - Org Name:CREEKSIDE KIDS DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SYCHRAVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:925-465-1200
Mailing Address - Street 1:11 HAMPTON CT
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502-6436
Mailing Address - Country:US
Mailing Address - Phone:909-660-1337
Mailing Address - Fax:
Practice Address - Street 1:1855 OLYMPIC BLVD STE 360
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5069
Practice Address - Country:US
Practice Address - Phone:925-465-1200
Practice Address - Fax:925-465-1250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-11
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental