Provider Demographics
NPI:1639206295
Name:FRISCH, MELISSA RENEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:RENEE
Last Name:FRISCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E 5900 S
Mailing Address - Street 2:SUITE #200
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5421
Mailing Address - Country:US
Mailing Address - Phone:801-293-1234
Mailing Address - Fax:
Practice Address - Street 1:2250 E MURRAY-HOLLADAY RD.
Practice Address - Street 2:#107
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117
Practice Address - Country:US
Practice Address - Phone:801-783-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000107521223G0001X
UT82338531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice