Provider Demographics
NPI:1265622526
Name:DAVID L. SYKES, DMD, LLC
Entity type:Organization
Organization Name:DAVID L. SYKES, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:SYKES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:609-653-6300
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ123891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2993805Medicaid
NJ2993805Medicaid