Provider Demographics
NPI:1588039861
Name:STEVEN K. FLICK DMD, PC
Entity type:Organization
Organization Name:STEVEN K. FLICK DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:FLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-373-2693
Mailing Address - Street 1:1355 N UNIVERSITY AVE
Mailing Address - Street 2:310
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2721
Mailing Address - Country:US
Mailing Address - Phone:801-373-2693
Mailing Address - Fax:801-374-6316
Practice Address - Street 1:1355 N UNIVERSITY AVE
Practice Address - Street 2:310
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-2721
Practice Address - Country:US
Practice Address - Phone:801-373-2693
Practice Address - Fax:801-374-6316
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000093182Medicare PIN