Pdc Provo LLC
NPI 1396893012ActiveOrganization· Dentist· Provo, UT
Dentist in Provo, Utah, registered in NPPES in January 2007, part of Platinum Dental Group LLC. The authorized official on file is Amber Johnson, Office Manager.
Overview
| NPI | 1396893012 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Platinum Dental Group LLC |
| NPI issued | Jan 8, 2007 |
| Last updated in NPPES | Jan 4, 2013 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist Primary | 122300000X | 6026130 | UT |
| Dentist, General Practice | 1223G0001X | 3192 | UT |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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