Provo PDC PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

PROVO PDC PLLC

Doing business as

Platinum Dental Care

Practice address

2255 N University Pkwy Ste 39
Provo, UT 84604-1503

Phone

(801) 426-6255

Fax

(801) 734-3714

NPI assigned

Aug 10, 2023

Last updated

Aug 10, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Juan Chavez, DMD

Title

Owner

Phone

(801) 691-1701

Specialties & licenses 4

Addresses

Other names 1

• Platinum Dental Care Doing business as

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691625600000",
    "number": "1467135822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 970176",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840970119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 N UNIVERSITY PKWY STE 39",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041503",
            "telephone_number": "801-426-6255",
            "fax_number": "801-734-3714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVO PDC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2023-08-10",
        "certification_date": "2023-08-10",
        "status": "A",
        "authorized_official_last_name": "CHAVEZ",
        "authorized_official_first_name": "JUAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-691-1701",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Platinum Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• General Practice Dentistry in Provo, UT
• Providers in Provo, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 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.