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General NPI Number Information
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NPI Number | 1801469838
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Entity Type | Individual
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Provider Name | KATRINA SICAM PAVLICHEK DMD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2021
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | PO BOX 106
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City | AMERY
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State | WI
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Zip | 54001-0106
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Country | US
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Telephone | 715-268-2103
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Fax |
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Provider Business Mailing Address
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Address Line | 3151 DERBY ST
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City | RIVER FALLS
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State | WI
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Zip | 54022-5791
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Country | US
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Telephone | 925-360-9980
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 106624
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 6001911-15
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License Number State | WI
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