Individual
DR. LAURA PROVINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
3191 S VALLEY ST, SALT LAKE CITY, UT 84109-4274
(801) 463-6657
Mailing address
3191 S VALLEY ST, SALT LAKE CITY, UT 84109-4274
(801) 463-6657
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
9070494-8903
UT
122300000X
Dentist
Primary
9070494-9922
UT
Other
Enumeration date
06/18/2014
Last updated
06/18/2014
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