Provider Demographics
NPI:1194731836
Name:SIKES, JAMES WILLIAM JR (DMD, MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:SIKES
Suffix:JR
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 FERN LOOP STE A
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4176
Mailing Address - Country:US
Mailing Address - Phone:318-585-7667
Mailing Address - Fax:318-585-6912
Practice Address - Street 1:6912 FERN LOOP STE A
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4176
Practice Address - Country:US
Practice Address - Phone:318-585-7667
Practice Address - Fax:318-585-6912
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA111171223S0112X
LA024422204E00000X
GA51272204E00000X
LA49121223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1849120Medicaid
LA1467912OtherUCCI
LA1467912OtherUCCI
LAH39414Medicare UPIN
LA1849120Medicaid