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Organization
FOREVER YOUNG DENTISTRY PLLC
Active
Organization
FOREVER YOUNG DENTISTRY PLLC
Active
Parent organization
FOREVER YOUNG DENTISTRY
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOREVER YOUNG DENTISTRY
Authorized official
MS. REYNA M MADRILES (CO-OWNER)
(801) 225-1630
Entity
Organization
Contact information
Practice address
2335 S. STATE STREET, STE #200, PROVO, UT 84606
(801) 225-1630
(801) 225-1630
Mailing address
2335 S. STATE STREET, STE #200, PROVO, UT 84606
(801) 225-1630
(801) 404-5802
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
564618729-001
—
UT
Enumeration date
09/30/2015
Last updated
09/30/2015
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