Provider Demographics
NPI:1013420462
Name:SYKES, STEVON RONALD
Entity Type:Individual
Prefix:DR
First Name:STEVON
Middle Name:RONALD
Last Name:SYKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 CRANE CREEK DR APT 1021
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3666
Mailing Address - Country:US
Mailing Address - Phone:810-531-3253
Mailing Address - Fax:
Practice Address - Street 1:USA DENTAL HEALTH ACTIVITY
Practice Address - Street 2:BLDG 38801, SUITE B&C
Practice Address - City:FT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5660
Practice Address - Country:US
Practice Address - Phone:706-787-6927
Practice Address - Fax:706-787-2082
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901022456122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901022456OtherMI LICENSURE