Katrina Sicam Pavlichek, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6001911-15 Issued in WI

Practice address

PO Box 106
Amery, WI 54001-0106

Phone

(715) 268-2103

NPI assigned

Jul 19, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Marks Dental Corporation, S.C.

  • Dentist
  • Amery, WI
  • NPI 1881303360
  NPD
• River Place Dental, Inc

  • Dental Clinic/Center
  • Amery, WI
  • NPI 1215177555
  NPD (past)
• Loreto R Sicam Jr DMD Inc

  • General Practice Dentistry
  • San Leandro, CA
  • NPI 1033252150
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1626652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1801469838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3151 DERBY ST",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "540225791",
            "telephone_number": "925-360-9980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PO BOX 106",
            "city": "AMERY",
            "state": "WI",
            "postal_code": "540010106",
            "telephone_number": "715-268-2103"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "699 Lewelling Blvd Ste 300",
            "address_purpose": "LOCATION",
            "city": "San Leandro",
            "state": "CA",
            "postal_code": "945791840",
            "country_code": "US",
            "telephone_number": "510-357-8960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PAVLICHEK",
        "first_name": "KATRINA",
        "middle_name": "SICAM",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-19",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "106624",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6001911-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.drsicam.com",
            "affiliation": "N",
            "endpointDescription": "Dental Website",
            "address_1": "699 Lewelling Blvd Ste 300",
            "city": "San Leandro",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945791840",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.river-place-dental.com",
            "affiliation": "N",
            "address_1": "PO Box 106",
            "city": "Amery",
            "state": "WI",
            "country_code": "US",
            "postal_code": "540010106",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jesse Ray Olson, DPT
• Lora Elizabeth Olson, OTR
• Hannah Marie Omann, FNP
• Amy Grace Ott, DDS
• Amy Lynn Panek, RN
• Gina Peck
• Jacqueline Peterson, D.C.
• Margie H Peterson, MD
• Jonathan David Platson, MSW, LCSW
• William Gregory Platz, M.D.

• General Practice Dentistry in Amery, WI
• Providers in Amery, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.