South Provo Pdc Pllc
NPI #1538946207 in Provo, Utah
Provider Information
- NPI Number
- 1538946207
- Entity Type
- Organization
- Organization Name
- South Provo Pdc Pllc
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Sep 14, 2023
- Last Updated
- Nov 8, 2023
Practice Location
Authorized Official
- Name
- VIVIAN BETANCOURT
- Title
- CREDENTIALING SPECIALIST
- Phone
- (801) 305-3465
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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