Provo Pediatric Dental

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

PROVO PEDIATRIC DENTAL

Practice address

745 N 500 W
Provo, UT 84601-1472

Phone

(801) 373-4200

Fax

(801) 373-0816

NPI assigned

Feb 1, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Barbara McCourt

Title

Office Manager

Phone

(435) 637-9590

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1675209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675209600000",
    "number": "1184320293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "391 N 400 E",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845012537",
            "telephone_number": "435-637-9590",
            "fax_number": "435-637-2228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 N 500 W",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011472",
            "telephone_number": "801-373-4200",
            "fax_number": "801-373-0816"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "391 N 400 E",
            "address_purpose": "LOCATION",
            "city": "Price",
            "state": "UT",
            "postal_code": "845012537",
            "country_code": "US",
            "telephone_number": "435-637-9590",
            "fax_number": "435-637-2228",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVO PEDIATRIC DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-01",
        "last_updated": "2023-02-01",
        "certification_date": "2023-02-01",
        "status": "A",
        "authorized_official_last_name": "MCCOURT",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "435-637-9590"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1811446727",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1912072620",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1598830291",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Provo Family Dentistry, LLC
• Provo House of Hope
• Provo Orem Family & Cosmetic Dentistry PLLC
• Provo PDC PLLC
• Provo Peak Chiropractic LLC
• Provo Premier Dental Group PLLC
• Provo Psychological Solutions
• Provo Sports and Family Chiropractic, Inc.
• Provo Surgery Center, LLC
• Provo Vision & Eye Care

• Pediatric Dentistry in Provo, UT
• Providers in Provo, UT by specialty
• Pediatric Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.