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FOREVER YOUNG DENTISTRY PLLC
NPI 1508236795
Clinic/Center - Dental in Provo, UT

Active since September 30, 2015
2335 S. STATE STREET, STE #200, PROVO, UT 84606(801) 225-1630(801) 225-1630 Get Directions Write a Review

NPPES record last updated: September 30, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Forever Young Dentistry Pllc NPPES

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

FOREVER YOUNG DENTISTRY PLLC (NPI 1508236795) is a healthcare organization registered as a dental in Provo, Utah and active in the NPI registry since September 2015. The organization lists Reyna M Madriles, Co-owner, as its authorized official.

NPPES Registry Identity

NPI1508236795
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameFOREVER YOUNG DENTISTRY PLLC
Location Address2335 S. STATE STREET, STE #200Provo, UT 84606
Mailing Address2335 S. State Street, Ste #200Provo, UT 84606 · (801) 225-1630 · Fax (801) 404-5802
Phone(801) 225-1630
Fax(801) 225-1630
Organization SubpartYesParent: Forever Young Dentistry
Authorized OfficialReyna M MadrilesCo-owner · (801) 225-1630
Enumeration DateSeptember 30, 2015
✔ NPI 1508236795 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
2335 S. STATE STREET, Provo, UT 84606
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Other Identifiers 1

Medicaid564618729-001UT

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 Forever Young Dentistry PLLC's NPI number?

The NPI number for Forever Young Dentistry PLLC is 1508236795. It was assigned to this organization in the NPPES registry on September 30, 2015.

Where is Forever Young Dentistry PLLC located?

Forever Young Dentistry PLLC is located at 2335 S. State Street Ste #200, Provo, UT 84606. The listed phone number is (801) 225-1630.

What is Forever Young Dentistry PLLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Forever Young Dentistry PLLC was last updated on September 30, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.