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Alex Provo — NPI 1750762555, Ada, MN | NPI Central

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Alex Provo

NPI 1750762555 · Dentist · Ada, MN

Provider details

NPI number: 1750762555
Entity type: Individual
Primary specialty: DentistDental Providers
Sex: Male
Sole proprietor: Yes
License: D13521 (MN)

Specialties & taxonomies

DentistPrimary122300000XLicense D13521 (MN)
Dental Providers

Practice location

200 E Main St

Ada, MN 56510-1354

Phone: (218) 784-7119

Approximate (ZIP-level) locationGet directions

More MN providers

Mailing address

18185 Park Dr

Detroit Lakes, MN 56501-7977

Registry dates

Enumerated: 2015-06-17
Last updated: 2015-06-17

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.