| South Provo Pdc Pllc | |
|
2211 E Valley Vista Way Provo UT 84606-5636 | |
| (385) 412-6964 | |
| (385) 248-5034 |
| Full Name | South Provo Pdc Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2211 E Valley Vista Way, Provo, Utah |
| Authorized Official Name and Position | Vivian Betancourt (CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 8013053465 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Provo Pdc Pllc Po Box 970185 Orem UT 84097-0185 Ph: (801) 691-1701 | South Provo Pdc Pllc 2211 E Valley Vista Way Provo UT 84606-5636 Ph: (385) 412-6964 |
| NPI Number | 1538946207 |
|---|---|
| Provider Enumeration Date | 09/14/2023 |
| Last Update Date | 11/08/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538946207 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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