| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 85 N 500 W, Provo, Utah |
| Authorized Official Name and Position | Kim Castaneda (OFFICE MANAGER) |
| Authorized Official Contact | 8013738791 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
85 N 500 W Provo UT 84601-2647 Ph: (801) 373-8791 | 85 N 500 W Provo UT 84601-2647 Ph: (801) 373-8791 |
| NPI Number | 1851802813 |
|---|---|
| Provider Enumeration Date | 10/18/2017 |
| Last Update Date | 10/18/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851802813 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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