Family Legacy Dental, Llc

LBN: Family Legacy Dental, Llc
Family Legacy Dental, Llc is an health care organization with primary practice located at 845 N 100 W Suite 100, Orem UT 84057-3180. The organization recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Pediatric Dentistry. Dental Providers / General Practice is the primary health care specialty. Family Legacy Dental, Llc can be contacted via phone (801) 227-5080, or through Fullmer, Lamona Marie via phone (801) 227-5080.

Contact Information

Primary practice address
845 N 100 W Suite 100 Orem UT 84057-3180
Phone: (801) 227-5080
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Fullmer, Lamona Marie
Phone: (801) 227-5080

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 5672963-0160 Utah
Dental Providers / Pediatric Dentistry 1223P0221X 5672963-0160 Utah

Profile Details

NPI number 1982721114
LBN Legal business name Family Legacy Dental, Llc
DBA Doing business as
Authorized official Fullmer, Lamona Marie
Entity Organization
Organization subpart 1 No
Enumeration date Mar 23rd, 2007
Last updated Aug 22nd, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982721114 NPPES
Utah MEDICAID 363064330001
Utah MEDICAID 475132674001
Utah MEDICAID 529361668001
Utah MEDICAID 529779405001
Utah MEDICAID 529636043001

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