Provider Demographics
NPI:1730276726
Name:SYKORA, KIM CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:CHARLES
Last Name:SYKORA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SUNNYSIDE RD
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19373-1018
Mailing Address - Country:US
Mailing Address - Phone:484-899-6480
Mailing Address - Fax:
Practice Address - Street 1:606 E MARSHALL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-4467
Practice Address - Country:US
Practice Address - Phone:610-696-9119
Practice Address - Fax:610-696-9170
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0355501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADS035550OtherSTATE DENTAL LICENSE