Provider Demographics
NPI:1730116351
Name:SYKES, SHANE WILLIAM (DMD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:WILLIAM
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 1:855 W 7TH ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-2745
Mailing Address - Country:US
Mailing Address - Phone:775-322-5016
Mailing Address - Fax:
Practice Address - Street 1:855 W 7TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-2745
Practice Address - Country:US
Practice Address - Phone:775-322-5016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV61451223G0001X
IDD-39561223G0001X
AK12601223G0001X
UT6313641-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice