Provider Demographics
NPI:1184623480
Name:BRICKEY, THOMAS F (DMD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:BRICKEY
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 1:3191 VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84109-4200
Mailing Address - Country:US
Mailing Address - Phone:801-463-6657
Mailing Address - Fax:801-463-0552
Practice Address - Street 1:3191 VALLEY ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84109-4274
Practice Address - Country:US
Practice Address - Phone:801-463-6657
Practice Address - Fax:801-463-0552
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2636191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice