Academy Dental LLC

NPI #1184132623 in Provo, Utah

Provider Information

NPI Number: 1184132623
Entity Type: Organization
Organization Name: Academy Dental LLC
Subpart: Yes (part of a larger organization)
Parent Organization: ACADEMY DENTAL LLC
Primary Specialty: Advanced Practice Dental Therapist
Enumeration Date: Jan 18, 2018
Last Updated: Jan 18, 2018

Practice Location

Address: 488 N 100 E ST.
City: Provo
State: Utah
ZIP Code: 84606
Phone: (801) 374-0867

Authorized Official

Name: DR. CORBIN MATTHEWS, DMD
Title: OWNER
Phone: (801) 473-6455

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Advanced Practice Dental Therapist	125K00000X	Primary

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