Provider Demographics
NPI:1619677689
Name:SIKON, SAMUEL PERRY (DDS)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:PERRY
Last Name:SIKON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SLOCOMB
Mailing Address - State:AL
Mailing Address - Zip Code:36375-6081
Mailing Address - Country:US
Mailing Address - Phone:618-967-4105
Mailing Address - Fax:
Practice Address - Street 1:2001 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3003
Practice Address - Country:US
Practice Address - Phone:618-967-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.007451-C11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice