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PDC PROVO LLC
NPI 1396893012
Dentist in Provo, UT

Active since January 08, 2007
2520 N UNIV AVE, SUITE 101, PROVO, UT 84604(801) 426-6255(801) 224-2966 Get Directions Write a Review

NPPES record last updated: January 4, 2013. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Pdc Provo Llc NPPES

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

PDC PROVO LLC (NPI 1396893012) is a healthcare organization registered as a dentist in Provo, Utah and active in the NPI registry since January 2007. The organization lists Amber Johnson, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1396893012
Entity TypeOrganization
Primary Taxonomy122300000X
Legal Business NamePDC PROVO LLC
Location Address2520 N UNIV AVE, SUITE 101Provo, UT 84604
Mailing Address2520 N Univ Ave, Suite 101Provo, UT 84604 · (801) 426-6255 · Fax (801) 224-2966
Phone(801) 426-6255
Fax(801) 224-2966
Organization SubpartYesParent: Platinum Dental Group Llc
Authorized OfficialAmber JohnsonOffice Manager · (801) 426-6255
Enumeration DateJanuary 8, 2007
Last NPPES UpdateJanuary 4, 2013
✔ NPI 1396893012 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in UT · 6026130
Definition
A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Also ListedDentist · General PracticeTaxonomy 1223G0001X · License 3192 (UT)
2520 N UNIV AVE, Provo, UT 84604
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Other Identifiers 1

Medicaid529113131001UT

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 MULTIPLE 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 Pdc Provo LLC's NPI number?

The NPI number for Pdc Provo LLC is 1396893012. It was assigned to this organization in the NPPES registry on January 8, 2007.

Where is Pdc Provo LLC located?

Pdc Provo LLC is located at 2520 N Univ Ave Suite 101, Provo, UT 84604. The listed phone number is (801) 426-6255.

What is Pdc Provo LLC's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Pdc Provo LLC was last updated on January 4, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.