Provider Demographics
NPI:1629075460
Name:SYKES, DAVID L (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:SYKES
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 1:524 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:LINWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08221-1213
Mailing Address - Country:US
Mailing Address - Phone:609-653-6300
Mailing Address - Fax:609-653-4204
Practice Address - Street 1:524 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:LINWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08221-1213
Practice Address - Country:US
Practice Address - Phone:609-653-6300
Practice Address - Fax:609-653-4204
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD10123891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ222318110OtherNJ TAX ID#
NJD1012389OtherNJ DENTAL LICENSE
NJ2993805Medicaid
NJ2993805-01Medicaid