Organization
PROVIDENCE PDC PLLC
Active
Other names
Platinum Dental Care-Providence
Organization subpart
No
Provider details
NPI number
Authorized official
JACOB WARNER (CREDENTIALING MANAGER)
(801) 691-1701
Entity
Organization
Contact information
Practice address
169 N GATEWAY DR, SUITE #105, PROVIDENCE, UT 84332-9861
(435) 610-2474
Mailing address
PO BOX 970238, OREM, UT 84097-0309
(801) 691-1701
(801) 335-6551
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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