Laura Provine, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

9070494-9922 Issued in UT

Practice address

3191 S Valley St
Salt Lake City, UT 84109-4274

Phone

(801) 463-6657

NPI assigned

Jun 18, 2014

Last updated

Jun 18, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1403049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403049600000",
    "number": "1912311879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3191 S VALLEY ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841094274",
            "telephone_number": "801-463-6657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3191 S VALLEY ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841094274",
            "telephone_number": "801-463-6657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVINE",
        "first_name": "LAURA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-18",
        "last_updated": "2014-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "9070494-9922",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "9070494-8903",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen G Protas, D.O.
• Brenda Proulx
• Megan Prouty, MD
• Aaron Provance, MD
• Samantha Lee Provenzano
• Justin D. Provo, MD
• Brooke Stephanie Provost, M.D.
• Courtney Lynn Provost
• Angela Marie Provstgaard
• Gail Lynn Pruden, NNP

• Dentist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.