Pdc Provo LLC
Pdc Provo LLC is a healthcare organization registered as Dentist in Provo, UT, holding Type 2 (organization) NPI 1396893012 since 2007. The authorized official on file is Amber Johnson, Office Manager.
✓ Active NPI ✓ Valid NPI checksum Organization subpart
| NPI | 1396893012 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Pdc Provo LLC |
| Parent organization | Platinum Dental Group LLC |
| Practice address | 2520 N UNIV AVE, SUITE 101, Provo, UT, 84604 |
| Phone | 8014266255 |
| Fax | 8012242966 |
| Enumeration date | 2007-01-08 |
| Last updated in NPPES | 2013-01-04 |
Authorized official
| Name | Amber Johnson |
|---|---|
| Title | Office Manager |
| Phone | 8014266255 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 1223G0001X | General Practice Dentistry | Secondary | 3192 | UT |
| 122300000X | Dentist | Primary | 6026130 | UT |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 529113131001 | Medicaid | UT | — |
Copy-ready billing details
Provider: Pdc Provo LLC NPI: 1396893012 Taxonomy: 122300000X (Dentist) Address: 2520 N UNIV AVE, SUITE 101, Provo, UT, 84604
Verify this record
Cross-check NPI 1396893012 against the authoritative CMS record: view Pdc Provo LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Pdc Provo LLC?
Who is the authorized official for Pdc Provo LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2013-01-04.