Provider Demographics
NPI:1053607648
Name:FRESQUES, CANDICE NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:NICOLE
Last Name:FRESQUES
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7555 S CENTER VIEW CT STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1971
Mailing Address - Country:US
Mailing Address - Phone:801-562-0115
Mailing Address - Fax:
Practice Address - Street 1:7555 S CENTER VIEW CT STE 201
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1971
Practice Address - Country:US
Practice Address - Phone:801-562-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8331674-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice