Provider Demographics
NPI:1588044721
Name:STICKA DENTAL CLINIC, P.C.
Entity Type:Organization
Organization Name:STICKA DENTAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:STICKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:701-483-3462
Mailing Address - Street 1:239 14TH ST W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-3118
Mailing Address - Country:US
Mailing Address - Phone:701-483-3462
Mailing Address - Fax:
Practice Address - Street 1:239 14TH ST W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-3118
Practice Address - Country:US
Practice Address - Phone:701-483-3462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2135261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental