Alex Provo
Alex Provo is a Dentist in Ada, Minnesota. Practices as a sole proprietor. Licensed in Minnesota.
- Licensed in
- MN
- In the registry since
- 2015
Practice location Address checks out
200 E Main StAda, MN 56510-1354
Phone: (218) 784-7119
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Specialties & licences
| Dentist (primary) | Taxonomy 122300000X · Licence D13521 (MN) |
|---|
Record details
| NPI number | 1750762555 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | June 17, 2015 |
| Last updated in NPPES | June 17, 2015 |
| Mailing address | 18185 Park Dr, Detroit Lakes, MN 56501-7977 |