| Forever Young Dentistry Pllc | |
|
2335 S. State Street Ste #200 Provo UT 84606 | |
| (801) 225-1630 | |
| (801) 225-1630 |
| Full Name | Forever Young Dentistry Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2335 S. State Street, Provo, Utah |
| Authorized Official Name and Position | Reyna M Madriles (CO-OWNER) |
| Authorized Official Contact | 8012251630 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Forever Young Dentistry Pllc 2335 S. State Street Ste #200 Provo UT 84606 Ph: (801) 225-1630 | Forever Young Dentistry Pllc 2335 S. State Street Ste #200 Provo UT 84606 Ph: (801) 225-1630 |
| NPI Number | 1508236795 |
|---|---|
| Provider Enumeration Date | 09/30/2015 |
| Last Update Date | 09/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508236795 | NPI | - | NPPES |
| 564618729-001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (Utah) | Primary |
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