Pdc Provo Llc

LBN: Pdc Provo Llc
Pdc Provo Llc is an health care organization with primary practice located at 2520 N Univ Ave Suite 101, Provo UT 84604. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / Dentist is the primary health care specialty. Pdc Provo Llc can be contacted via phone (801) 426-6255, or through Johnson, Amber via phone (801) 426-6255.

Contact Information

Primary practice address
2520 N Univ Ave Suite 101 Provo UT 84604
Phone: (801) 426-6255
Fax: (801) 224-2966
Website:
Map and Directions
Authorized official contact:
Name: Johnson, Amber
Phone: (801) 426-6255

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 6026130 Utah
Dental Providers / General Practice 1223G0001X 3192 Utah

Profile Details

NPI number 1396893012
LBN Legal business name Pdc Provo Llc
DBA Doing business as
Authorized official Johnson, Amber
Entity Organization
Organization subpart 1 Yes
Enumeration date Jan 8th, 2007
Last updated Jan 4th, 2013 - about 12 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396893012 NPPES
Utah MEDICAID 529113131001

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