Organization
FAMILIES FIRST ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING)
(505) 850-3769
Entity
Organization
Contact information
Practice address
263 COUNTRY CLUB DR STE 104, STANSBURY PARK, UT 84074-9602
(801) 515-5858
Mailing address
PO BOX 95868, SOUTH JORDAN, UT 84095-0868
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
11/07/2023
Last updated
11/07/2023
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