Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Pdc Provo LLC

Organization Dentist · NPI 1396893012

Pdc Provo LLC is a Dentist in Provo, Utah. Licensed in Utah. Registered with an NPI since 2007.

Licensed in
UT
In the registry since
2007
Specialties on file
2
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2520 N Univ Ave Ste 101
Provo, UT 84604
Phone: (801) 426-6255
Fax: (801) 224-2966
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 6026130 (UT)
General Practice Dentistry Taxonomy 1223G0001X · Licence 3192 (UT)

Record details

NPI number1396893012
Entity typeOrganization (Type 2)
Organization subpartYes
Parent organizationPlatinum Dental Group LLC
Authorized official Amber Johnson — Office Manager · (801) 426-6255
NPI enumeratedJanuary 8, 2007
Last updated in NPPESJanuary 4, 2013
Mailing address2520 N Univ Ave, Suite 101, Provo, UT 84604

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