Organization
ACADEMY DENTAL LLC
Active
Organization
ACADEMY DENTAL LLC
Active
Parent organization
ACADEMY DENTAL LLC
Other names
Academy Square Dental Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
ACADEMY DENTAL LLC
Authorized official
DR. CORBIN MATTHEWS DMD (OWNER)
(801) 473-6455
Entity
Organization
Contact information
Practice address
488 N 100 E ST., PROVO, UT 84606
(801) 374-0867
Mailing address
488 N 100 E ST., PROVO, UT 84606
(801) 374-0867
Taxonomy
Speciality
Code
Description
License number
State
125K00000X
Advanced Practice Dental Therapist
Primary
372923
UT
125K00000X
Advanced Practice Dental Therapist
8372408-9922
UT
Other
Enumeration date
01/18/2018
Last updated
01/18/2018
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