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Organization
FAMILIES FIRST PEDIATRIC DENTISTRY
Active
Organization
FAMILIES FIRST PEDIATRIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING SPECIALIST)
(505) 850-3769
Entity
Organization
Contact information
Practice address
13825 S REDWOOD RD STE 100, BLUFFDALE, UT 84065-5241
(801) 515-5858
Mailing address
PO BOX 95868, SOUTH JORDAN, UT 84095-0868
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
NULL
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
11/07/2023
Last updated
07/01/2025
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