Provider Demographics
NPI:1811215395
Name:FABRIZIO, CORY J (DMD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:J
Last Name:FABRIZIO
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 1:2741 E CANTON LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84092-7126
Mailing Address - Country:US
Mailing Address - Phone:801-566-0971
Mailing Address - Fax:
Practice Address - Street 1:9233 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5808
Practice Address - Country:US
Practice Address - Phone:801-566-0971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-09
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist