Provo Premier Dental Group PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PROVO PREMIER DENTAL GROUP PLLC

Doing business as

Advanced Dental Care

Practice address

777 N 500 W Ste 204
Provo, UT 84601-1597

Phone

(801) 374-2182

NPI assigned

Feb 17, 2022

Organization subpart

No

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

Authorized official

Name

David Smith, DDSNPI 1992052682

Title

Owner

Phone

(801) 375-1414

Specialties & licenses 2

Addresses

Other names 1

• Advanced Dental Care Doing business as

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• David Hyrum Smith, DDS

  • Dentist
  • Tripler AMC, HI
  • NPI 1992052682
  NPD Authorized official
• Todd Clinton Groesbeck, D.M.D

  • General Practice Dentistry
  • Provo, UT
  • NPI 1780939348
  NPD (past)
• Mark D. McKell, D.D.S.

  • General Practice Dentistry
  • Provo, UT
  • NPI 1629178728
  NPD (past)

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

{
    "created_epoch": "1645056000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713830400000",
    "number": "1396490314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 W 2230 N STE 101",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846047582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 N 500 W STE 204",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846011597",
            "telephone_number": "801-374-2182"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "247 W 2230 N Ste 101",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846047582",
            "country_code": "US",
            "telephone_number": "801-375-1414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVO PREMIER DENTAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-17",
        "last_updated": "2024-04-23",
        "certification_date": "2024-04-23",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-375-1414",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dentist in Provo, UT
• Providers in Provo, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2024; 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.