Organization
PROVO DOWNTOWN DENTAL, LLC
Active
Other names
Provo Downtown Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MISS KIM CASTANEDA (OFFICE MANAGER)
(801) 373-8791
Entity
Organization
Contact information
Practice address
85 N 500 W, PROVO, UT 84601-2647
(801) 373-8791
Mailing address
85 N 500 W, PROVO, UT 84601-2647
(801) 373-8791
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2017
Last updated
10/18/2017
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