Organization
FOREVER YOUNG DENTISTRY PLLC
Active
Parent organization
FOREVER YOUNG DENTISTRY
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOREVER YOUNG DENTISTRY
Authorized official
MS. REYNA M MADRILES (CO-OWNER)
(801) 225-1630
Entity
Organization
Contact information
Practice address
2335 S. STATE STREET, STE #200, PROVO, UT 84606
(801) 225-1630
(801) 225-1630
Mailing address
2335 S. STATE STREET, STE #200, PROVO, UT 84606
(801) 225-1630
(801) 404-5802
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
564618729-001
—
UT
Enumeration date
09/30/2015
Last updated
09/30/2015
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