1013420462 NPI number — DR. STEVON RONALD SYKES

Table of content: DR. STEVON RONALD SYKES (NPI 1013420462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013420462 NPI number — DR. STEVON RONALD SYKES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYKES
Provider First Name:
STEVON
Provider Middle Name:
RONALD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013420462
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
680 CRANE CREEK DR APT 1021
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30907-3666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-531-3253
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USA DENTAL HEALTH ACTIVITY
Provider Second Line Business Practice Location Address:
BLDG 38801, SUITE B&C
Provider Business Practice Location Address City Name:
FT GORDON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30905-5660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-787-6927
Provider Business Practice Location Address Fax Number:
706-787-2082
Provider Enumeration Date:
11/08/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2901022456 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2901022456 . This is a "MI LICENSURE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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