Organization
BRIGHTSIDE ORAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONIE GONZALES (CREDENTIALING MANAGER)
(505) 850-3769
Entity
Organization
Contact information
Practice address
5136 N CAMBRIDGE WAY, STANSBURY PARK, UT 84074-8279
(801) 773-8644
(801) 773-9828
Mailing address
5136 N CAMBRIDGE WAY, STANSBURY PARK, UT 84074-8279
(801) 773-8644
(801) 773-9828
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
04/09/2026
Last updated
04/09/2026
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