Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | D4774 | AZ |
NPI | 1043218423 |
---|---|
Provider Name | Dr. Kenneth Joseph Frick |
First Address | Scottsdale, AZ 85255-3406 |
Second Address | Leawood, KS 66211-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2005 |
Last Update Date | 12/07/2011 |