Organization
GENESIS DENTAL OF PROVO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JASON D CASTO (OWNER/MEMBER)
(801) 870-0625
Entity
Organization
Contact information
Practice address
2255 N UNIVERSITY PKWY STE 39, PROVO, UT 84604-1503
(801) 319-6743
Mailing address
2255 N UNIVERSITY PKWY STE 39, PROVO, UT 84604-1503
(801) 319-6743
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
11/09/2017
Last updated
11/09/2017
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