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777 N 500 W Ste 204 Provo UT 84601-1597 | |
| (801) 374-2182 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 777 N 500 W Ste 204, Provo, Utah |
| Authorized Official Name and Position | David Smith (OWNER) |
| Authorized Official Contact | 8013751414 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
247 W 2230 N Ste 101 Provo UT 84604-7582 Ph: () - | 777 N 500 W Ste 204 Provo UT 84601-1597 Ph: (801) 374-2182 |
| NPI Number | 1396490314 |
|---|---|
| Provider Enumeration Date | 02/17/2022 |
| Last Update Date | 04/23/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396490314 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
| 332BC3200X | Durable Medical Equipment & Medical Supplies - Customized Equipment | (* (Not Available)) | Secondary |
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