Provider Demographics
NPI:1558116137
Name:SICKLER, NATHAN ALFRED (DMD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALFRED
Last Name:SICKLER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 COOKE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-2020
Mailing Address - Country:US
Mailing Address - Phone:406-939-5541
Mailing Address - Fax:
Practice Address - Street 1:116 N MEADE AVE
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1604
Practice Address - Country:US
Practice Address - Phone:406-377-8265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-28284122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist