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

South Provo Pdc PLLC

Organization Dental Clinic/Center · NPI 1538946207

South Provo Pdc PLLC is a Dental Clinic/Center in Provo, Utah. Registered with an NPI since 2023.

In the registry since
2023
What do these letters mean?
PLLC — Professional limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2211 E Valley Vista Way
Provo, UT 84606-5636
Phone: (385) 412-6964
Fax: (385) 248-5034
Show map & directions

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

Specialties & licences

Dental Clinic/Center (primary) Taxonomy 261QD0000X

Record details

NPI number1538946207
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Vivian Betancourt — Credentialing Specialist · (801) 305-3465
NPI enumeratedSeptember 14, 2023
Last updated in NPPESNovember 8, 2023
Certification dateNovember 8, 2023
Mailing addressPo Box 970185, Orem, UT 84097-0185

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