| NPI | 1295379659 |
|---|---|
| Doing Business As | PROVO DENTAL |
| Entity Type | Organization |
| Authorized Contact | STACY YOUNG Office Manager 801-374-8205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2019-10-29 |