Genesis Dental of Provo

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

GENESIS DENTAL OF PROVO

Practice address

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

Phone

(801) 319-6743

NPI assigned

Nov 9, 2017

Organization subpart

No

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

Authorized official

Name

Jason D Casto

Title

Owner/Member

Phone

(801) 870-0625

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1510185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510185600000",
    "number": "1629581871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2255 N UNIVERSITY PKWY STE 39",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846041503",
            "telephone_number": "801-319-6743"
        },
        {
            "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": "801-319-6743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS DENTAL OF PROVO",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-09",
        "last_updated": "2017-11-09",
        "status": "A",
        "authorized_official_last_name": "CASTO",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "801-870-0625"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliza Rachelle Gedge, PH.D., LP
• Jennifer Gee, LCSW
• Alyssa Tabitha Geiger
• Margaret Victoria Geilman, APRNI
• Hannah Jean Gellerstedt
• Hillary Gentillon
• George C Gourley, DO
• Christa George
• Laurel Diane George
• Lisa J George, PA-C

• Dental Clinic/Center in Provo, UT
• Providers in Provo, UT by specialty
• Dental Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; 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.