Provider Demographics
NPI:1609874866
Name:SICKINGER, DAVID KIRKWOOD (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KIRKWOOD
Last Name:SICKINGER
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 1:316 N TUSCARAWAS AVE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-3142
Mailing Address - Country:US
Mailing Address - Phone:330-364-6422
Mailing Address - Fax:
Practice Address - Street 1:316 N TUSCARAWAS AVE
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-3142
Practice Address - Country:US
Practice Address - Phone:330-364-6422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0691854Medicaid