SOUTH PROVO PDC PLLC

PROVO, UT
NPI1538946207
Entity TypeOrganization
Authorized ContactVIVIAN BETANCOURT
Credentialing Specialist
801-305-3465
Organization Subpart ?No
Primary Taxonomy261QD0000X Clinic/Center, Dental
Enumeration Date2023-09-14
Last Update Date2023-11-08
Business Address
SOUTH PROVO PDC PLLC
2211 E VALLEY VISTA WAY
PROVO, UT 84606-5636
Phone number: 385-412-6964
Mailing Address
SOUTH PROVO PDC PLLC
PO BOX 970185
OREM, UT 84097-0185
Phone number: 801-691-1701
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