Organization
PROVO DENTAL CARE LLC
Active
Other names
Stonehaven Dental - Provo, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
STEVE JAMES (CFO)
(502) 254-8504
Entity
Organization
Contact information
Practice address
1355 N UNIVERSITY AVE, SUITE 330, PROVO, UT 84604-2721
(801) 874-2451
Mailing address
PO BOX 437169, LOUISVILLE, KY 40253-7169
(502) 254-8501
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
06/03/2014
Last updated
06/03/2014
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