Provo Premier Dental Group Pllc

NPI #1396490314 in Provo, Utah

Provider Information

NPI Number: 1396490314
Entity Type: Organization
Organization Name: Provo Premier Dental Group Pllc
Primary Specialty: Dentist
Enumeration Date: Feb 17, 2022
Last Updated: Apr 23, 2024

Practice Location

Address: 777 N 500 W STE 204
City: Provo
State: Utah
ZIP Code: 84601-1597
Phone: (801) 374-2182

Authorized Official

Name: DAVID SMITH, DDS
Title: OWNER
Phone: (801) 375-1414

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies - Customized Equipment — Customized Equipment	332BC3200X
Dentist	122300000X	Primary

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