Organization
PROVO FAMILY DENTISTRY, LLC
Active
Other names
The Dental Edge
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHRISTY HARDMAN (OFFICE MANAGER)
(801) 373-2693
Entity
Organization
Contact information
Practice address
1355 N UNIVERSITY AVE STE 310, PROVO, UT 84604-2721
(801) 373-2693
Mailing address
1355 N UNIVERSITY AVE STE 310, PROVO, UT 84604-2721
(801) 373-2693
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
275985-9922
UT
Other
Enumeration date
10/16/2017
Last updated
10/16/2017
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