Organization
PROVO PREMIER DENTAL GROUP PLLC
Active
Other names
Advanced Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID SMITH DDS (OWNER)
(801) 375-1414
Entity
Organization
Contact information
Practice address
777 N 500 W STE 204, PROVO, UT 84601-1597
(801) 374-2182
Mailing address
247 W 2230 N STE 101, PROVO, UT 84604-7582
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Enumeration date
02/17/2022
Last updated
04/23/2024
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