# FAMILIES FIRST PEDIATRIC DENTISTRY

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

## Provider details

- **NPI number:** 1700464955
- **Authorized official:** EBONIE GONZALES (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (505) 850-3769

## Contact information

- **Practice address:** 4651 W 13400 S STE 110, RIVERTON, UT 84096-6483
- **Practice address phone:** (801) 450-1250
- **Mailing address:** PO BOX 95868, SOUTH JORDAN, UT 84095-0868
- **Mailing address phone:** (801) 450-1250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | — | NULL | Yes |
| 1223P0221X | Pediatric Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 03/30/2021
- **Last updated:** 07/01/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1013479492 | — | UT |
| 05 | — | 1215379540 | — | UT |
| 05 | — | 1811237076 | — | UT |
| 05 | — | 1831165224 | — | UT |
| 05 | — | 1932399391 | — | UT |