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Contact Information

PROVO PDC PLLC
2255 N UNIVERSITY PKWY STE 39
PROVO, UT84604-1503
 Phone: 801-426-6255
 Fax: 801-734-3714
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

General Practice

1223G0001X
 

Oral and Maxillofacial Surgery

1223S0112X 19 Oral Surgery (Dentist only)
 

Orthotist

222Z00000X 55 Individual Certified Orthotist
 

Periodontics

1223P0300X
Indicates primary specialty

NPI Profile & details for PROVO PDC PLLC · (Female)

NPI Number 1467135822
Status Active
Credentials
Entity Individual
Enumeration date 08/10/2023
Last updated 08/10/2023 - About 3 years ago
Sole proprietor 1 Not specified
Identifiers Not Available
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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