Provider Demographics
NPI:1710251871
Name:AMICK, SIERRA BROOKE (RDA)
Entity Type:Individual
Prefix:MS
First Name:SIERRA
Middle Name:BROOKE
Last Name:AMICK
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 MORNING STAR DR
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9260
Mailing Address - Country:US
Mailing Address - Phone:209-588-8400
Mailing Address - Fax:209-588-8811
Practice Address - Street 1:800 MORNING STAR DR
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-9260
Practice Address - Country:US
Practice Address - Phone:209-588-8400
Practice Address - Fax:209-588-8811
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89454126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant