Provider Demographics
NPI:1043218423
Name:FRICK, KENNETH JOSEPH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:JOSEPH
Last Name:FRICK
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:7500 E PINNACLE PEAK RD
Mailing Address - Street 2:SUITE #A100
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3406
Mailing Address - Country:US
Mailing Address - Phone:480-585-2824
Mailing Address - Fax:480-585-2391
Practice Address - Street 1:11201 NALL AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1926
Practice Address - Country:US
Practice Address - Phone:913-491-0056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD47741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics