ACADEMY SQUARE DENTAL CARE
NPI 1184132623
Advanced Practice Dental Therapist in Provo, UT

Q: What is Academy Dental LLC's NPI number?

The NPI number for Academy Dental LLC is 1184132623. It was assigned to this organization in the NPPES registry on January 18, 2018. The provider is doing business as Academy Square Dental Care.

Q: What is Academy Dental LLC's specialty?

The primary specialty registered for this NPI is Advanced Practice Dental Therapist with taxonomy code 125K00000X.

Active since January 18, 2018

488 N 100 E ST., PROVO, UT 84606(801) 374-0867 Get Directions Write a Review

NPPES record last updated: January 18, 2018. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About Academy Square Dental Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ACADEMY SQUARE DENTAL CARE (NPI 1184132623) is a healthcare organization registered as an advanced practice dental therapist in Provo, Utah and active in the NPI registry since January 2018. The organization lists Corbin Matthews, Owner, as its authorized official.

NPPES Registry Identity

NPI1184132623

Entity TypeOrganization

Primary Taxonomy125K00000X

Legal Business NameACADEMY DENTAL LLC

Location Address488 N 100 E ST.Provo, UT 84606

Mailing Address488 N 100 E St.Provo, UT 84606 · (801) 374-0867

Phone(801) 374-0867

Organization SubpartYes

Authorized OfficialCorbin MatthewsOwner · (801) 473-6455

Enumeration DateJanuary 18, 2018

✔ NPI 1184132623 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAdvanced Practice Dental TherapistDental Providers

Taxonomy Code125K00000X

Licenses✔ Licensed in UT · 372923✔ Licensed in UT · 8372408-9922

Definition

An Advanced Practice Dental Therapist is:
(1) A dental therapist who has completed additional training beyond basic dental therapy education and provides dental services in accordance with state advanced practice dental therapist laws or statutes; or
(2) A dental hygienist with a graduate degree in advanced dental therapy prepared for independent and interdependent decision making and direct accountability for clinical judgment across the dental health care continuum.

The individual has been authorized by the relevant state board or a tribal entity to provide services under the remote supervision of a dentist. The functions of the advanced practice dental therapist vary based on the needs of the dentist, the educational preparation of the advanced practice dental therapist and state dental practice acts and regulations.

488 N 100 E ST., Provo, UT 84606

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Other Names 1

Doing Business AsAcademy Square Dental Care

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Academy Dental LLC's NPI number?

The NPI number for Academy Dental LLC is 1184132623. It was assigned to this organization in the NPPES registry on January 18, 2018. The provider is doing business as Academy Square Dental Care.

Where is Academy Dental LLC located?

Academy Dental LLC is located at 488 N 100 E St., Provo, UT 84606. The listed phone number is (801) 374-0867.

What is Academy Dental LLC's specialty?

The primary specialty registered for this NPI is Advanced Practice Dental Therapist with taxonomy code 125K00000X.

When was this NPI record last updated?

The NPPES record for Academy Dental LLC was last updated on January 18, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.