MEDICARE: ADC PROVO LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1558212936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADC PROVO LLC

Provider Business Mailing Address
First Line	:	247 W 2230 N STE 101
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7582
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	247 W 2230 N STE 101
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7582
Country	:	US
Telephone Number	:	801-375-1414
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES COLE MCWHORTER
Credential	:
Telephone Number	:	801-592-4360

Provider Enumeration Date	:	02/03/2026
Last Update Date	:	02/03/2026

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Directions to “ADC PROVO LLC ” Practice Location

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