| Genesis Dental Of Provo | |
|
2255 N University Pkwy Ste 39 Provo UT 84604-1503 | |
| (801) 319-6743 | |
| Not Available |
| Full Name | Genesis Dental Of Provo |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 2255 N University Pkwy Ste 39, Provo, Utah |
| Authorized Official Name and Position | Jason D Casto (OWNER/MEMBER) |
| Authorized Official Contact | 8018700625 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Dental Of Provo 2255 N University Pkwy Ste 39 Provo UT 84604-1503 Ph: (801) 319-6743 | Genesis Dental Of Provo 2255 N University Pkwy Ste 39 Provo UT 84604-1503 Ph: (801) 319-6743 |
| NPI Number | 1629581871 |
|---|---|
| Provider Enumeration Date | 11/09/2017 |
| Last Update Date | 11/09/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629581871 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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