Provider Demographics
NPI:1487357000
Name:EBBEN-CARMODY, SYDNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:SYDNEY
Middle Name:
Last Name:EBBEN-CARMODY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SYDNEY
Other - Middle Name:
Other - Last Name:EBBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2702 8TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9138
Mailing Address - Country:US
Mailing Address - Phone:605-886-8096
Mailing Address - Fax:
Practice Address - Street 1:2702 8TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9138
Practice Address - Country:US
Practice Address - Phone:605-886-8096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD13991223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice