| Provo Pediatric Dental | |
|
745 N 500 W Provo UT 84601-1472 | |
| (801) 373-4200 | |
| (801) 373-0816 |
| Full Name | Provo Pediatric Dental |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 745 N 500 W, Provo, Utah |
| Authorized Official Name and Position | Barbara Mccourt (OFFICE MANAGER) |
| Authorized Official Contact | 4356379590 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Provo Pediatric Dental 391 N 400 E Price UT 84501-2537 Ph: (435) 637-9590 | Provo Pediatric Dental 745 N 500 W Provo UT 84601-1472 Ph: (801) 373-4200 |
| NPI Number | 1184320293 |
|---|---|
| Provider Enumeration Date | 02/01/2023 |
| Last Update Date | 02/01/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184320293 | NPI | - | NPPES |
| 1811446727 | Other | UT | TYPE 1 NPI |
| 1912072620 | Other | UT | TYPE 1 NPI |
| 1598830291 | Other | UT | TYPE 1 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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