| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 835 N 700 E, Provo, Utah |
| Authorized Official Name and Position | Todd C Groesbeck (OWNER) |
| Authorized Official Contact | 8013737700 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
835 N 700 E Provo UT 84606 Ph: (801) 373-7700 | 835 N 700 E Provo UT 84606 Ph: (801) 373-7700 |
| NPI Number | 1255769147 |
|---|---|
| Provider Enumeration Date | 10/31/2013 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255769147 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 8291219 (Utah) | Primary |
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