# FAMILY LEGACY DENTAL, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1982721114
- **Authorized official:** MRS. LAMONA MARIE FULLMER (OWNER)
- **Authorized official phone:** (801) 227-5080

## Contact information

- **Practice address:** 845 N 100 W, SUITE 100, OREM, UT 84057-3180
- **Practice address phone:** (801) 227-5080
- **Mailing address:** 845 N 100 W, SUITE 100, OREM, UT 84057-3180
- **Mailing address phone:** (801) 227-5080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5672963-0160 | UT | — |
| 1223P0221X | Pediatric Dentistry | 5672963-0160 | UT | Yes |

## Other

- **Enumeration date:** 03/23/2007
- **Last updated:** 09/11/2025

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 363064330001 | — | UT |
| 05 | — | 475132674001 | — | UT |
| 05 | — | 529361668001 | — | UT |
| 05 | — | 529636043001 | — | UT |
| 05 | — | 529779405001 | — | UT |