Provider Demographics
NPI:1053531095
Name:SYSKA, NILES A (DDS)
Entity type:Individual
Prefix:DR
First Name:NILES
Middle Name:A
Last Name:SYSKA
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 1:25520 STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9526
Mailing Address - Country:US
Mailing Address - Phone:352-735-2211
Mailing Address - Fax:
Practice Address - Street 1:25520 STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9526
Practice Address - Country:US
Practice Address - Phone:352-735-2211
Practice Address - Fax:352-735-5844
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30021205122300000X
FLDN17296122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist