Pdc Provo LLC

NPI #1396893012 in Provo, Utah

Provider Information

NPI Number: 1396893012
Entity Type: Organization
Organization Name: Pdc Provo LLC
Subpart: Yes (part of a larger organization)
Parent Organization: PLATINUM DENTAL GROUP LLC
Primary Specialty: Dentist
Enumeration Date: Jan 8, 2007
Last Updated: Jan 4, 2013

Practice Location

Address: 2520 N UNIV AVE
Address 2: SUITE 101
City: Provo
State: Utah
ZIP Code: 84604
Phone: (801) 426-6255

Authorized Official

Name: AMBER JOHNSON
Title: OFFICE MANAGER
Phone: (801) 426-6255

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X
Dentist	122300000X	Primary

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