| Full Name | Alex Provo |
|---|---|
| Gender | Male |
| Speciality | Dentist |
| Location | 200 E Main St, Ada, Minnesota |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750762555 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | D13521 (Minnesota) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Alex Provo, 18185 Park Dr, Detroit Lakes, MN 56501-7977 Ph: () - | Alex Provo, 200 E Main St, Ada, MN 56510-1354 Ph: (218) 784-7119 |
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› Verified 6 days ago
Dr. David A Resnick, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 200 E Main St, Ada, MN 56510 Phone: 218-784-7119 Fax: 218-784-2381 | |
Dr. Debra A Ettle, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 200 E Main St, Ada, MN 56510 Phone: 218-784-7119 Fax: 218-784-2381 |