Provo Family Dentistry, LLC

NPI #1063923258 in Provo, Utah

Provider Information

NPI Number: 1063923258
Entity Type: Organization
Organization Name: Provo Family Dentistry, LLC
Primary Specialty: Clinic/Center - Dental
Enumeration Date: Oct 16, 2017
Last Updated: Oct 16, 2017

Practice Location

Address: 1355 N UNIVERSITY AVE STE 310
City: Provo
State: Utah
ZIP Code: 84604-2721
Phone: (801) 373-2693

Authorized Official

Name: MRS. CHRISTY HARDMAN
Title: OFFICE MANAGER
Phone: (801) 373-2693

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Dental — Dental	261QD0000X	Primary

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