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ALEX PROVO
NPI 1750762555
Dentist in Ada, MN

Active since June 17, 2015Opted out of Medicare · through Jan 5, 2028

NPPES record last updated: June 17, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Alex Provo NPPES

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

ALEX PROVO (NPI 1750762555) is an individual dentist in Ada, Minnesota, licensed in Minnesota (D13521) and active in the NPI registry since June 2015. He has opted out of Medicare through January 5, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1750762555
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameALEX PROVO
Location Address200 E MAIN STAda, MN 56510-1354
Mailing Address18185 Park DrDetroit Lakes, MN 56501-7977
Phone(218) 784-7119
Sole ProprietorYes
Enumeration DateJune 17, 2015
✔ NPI 1750762555 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License✔ Licensed in MN · D13521
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.
200 E MAIN ST, Ada, MN 56510
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Alex Provo has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 5, 2016 through January 5, 2028.

Opt-Out Effective DateJanuary 5, 2016
Opt-Out In Effect ThroughJanuary 5, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 56510 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$85.82 typical visit price
range $56.00 – $168.28
Typical copayment $21.45 (range $14.00 – $42.07)
Most-billed visit code 99203
Established Patient
$69.74 typical visit price
range $18.32 – $138.04
Typical copayment $17.43 (range $4.58 – $34.51)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. DAVID A RESNICK D.D.S.
Dentist (General Practice)
200 E MAIN ST
ADA, MN 56510
Norman County (218) 784-7119
PRAIRIE DENTAL CENTERS PA
Dentist (General Practice)
200 E MAIN ST
ADA, MN 56510
Norman County (218) 784-7119
DR. DEBRA A ETTLE D.D.S.
Dentist (General Practice)
200 E MAIN ST
ADA, MN 56510
Norman County (218) 784-7119

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 Alex Provo's NPI number?

The NPI number for Alex Provo is 1750762555. It was assigned to this individual provider in the NPPES registry on June 17, 2015.

Where is Alex Provo located?

Alex Provo practices at 200 E Main St, Ada, MN 56510. The listed phone number is (218) 784-7119.

What is Alex Provo's specialty?

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

Is Alex Provo enrolled in Medicare?

No. Alex Provo has opted out of Medicare through January 5, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Alex Provo was last updated on June 17, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 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.