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Organization
FAMILY LEGACY DENTAL, LLC
Active
Organization
FAMILY LEGACY DENTAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAMONA MARIE FULLMER (OWNER)
(801) 227-5080
Entity
Organization
Contact information
Practice address
845 N 100 W, SUITE 100, OREM, UT 84057-3180
(801) 227-5080
Mailing address
845 N 100 W, SUITE 100, OREM, UT 84057-3180
(801) 227-5080
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
5672963-0160
UT
1223P0221X
Pediatric Dentistry
Primary
5672963-0160
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
363064330001
—
UT
05
—
475132674001
—
UT
05
—
529361668001
—
UT
05
—
529636043001
—
UT
05
—
529779405001
—
UT
Enumeration date
03/23/2007
Last updated
09/11/2025
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