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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

NPI # 1467135822
LBN Legal business name PROVO PDC PLLC
Authorized official JUAN CHAVEZ - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 08/10/2023
Last updated 08/10/2023 - About 3 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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