# BRIGHTSIDE ORAL SURGERY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154264844
- **Authorized official:** EBONIE GONZALES (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (505) 850-3769

## Contact information

- **Practice address:** 5459 W 7800 S STE 100, WEST JORDAN, UT 84081-6090
- **Practice address phone:** (801) 773-8644
- **Practice address fax:** (801) 773-9828
- **Mailing address:** 5459 W 7800 S STE 100, WEST JORDAN, UT 84081-6090
- **Mailing address phone:** (801) 773-8644
- **Mailing address fax:** (801) 773-9828

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | NULL | Yes |
| 204E00000X | Oral & Maxillofacial Surgery (D.M.D.) | — | — | Yes |

## Other

- **Enumeration date:** 04/09/2026
- **Last updated:** 04/09/2026