Provider Demographics
NPI:1639751852
Name:FRICK, JOSHUA CARLON (DMD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CARLON
Last Name:FRICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 N WILDFLOWER DR UNIT 51
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5352
Mailing Address - Country:US
Mailing Address - Phone:301-466-2298
Mailing Address - Fax:
Practice Address - Street 1:1377 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1476
Practice Address - Country:US
Practice Address - Phone:801-277-8222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12257951-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice