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
4651 W 13400 S STE 110, RIVERTON, UT 84096-6483
(801) 450-1250
Mailing address
PO BOX 95868, SOUTH JORDAN, UT 84095-0868
(801) 450-1250
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013479492
—
UT
05
—
1215379540
—
UT
05
—
1811237076
—
UT
05
—
1831165224
—
UT
05
—
1932399391
—
UT
Enumeration date
03/30/2021
Last updated
07/01/2025
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