Organization
PROVO OREM FAMILY & COSMETIC DENTISTRY PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON MICHAEL CAMPBELL D.D.S (PRESIDENT)
(706) 207-1102
Entity
Organization
Contact information
Practice address
2255 N UNIVERSITY PKWY, SUITE 39, PROVO, UT 84604-1588
(706) 207-1102
Mailing address
2255 N UNIVERSITY PKWY, SUITE 39, PROVO, UT 84604-1588
(706) 207-1102
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
87673189923
UT
Other
Enumeration date
04/03/2015
Last updated
04/03/2015
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