Organization
PROVO PDC PLLC
Active
Other names
Platinum Dental Care
Organization subpart
No
Provider details
NPI number
Authorized official
JUAN CHAVEZ DMD (OWNER)
(801) 691-1701
Entity
Organization
Contact information
Practice address
2255 N UNIVERSITY PKWY STE 39, PROVO, UT 84604-1503
(801) 426-6255
(801) 734-3714
Mailing address
PO BOX 970176, OREM, UT 84097-0119
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
222Z00000X
Orthotist
—
—
Other
Enumeration date
08/10/2023
Last updated
08/10/2023
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