| Family Legacy Dental, Llc | |
|
845 N 100 W Suite 100 Orem UT 84057-3180 | |
| (801) 227-5080 | |
| Not Available |
| Full Name | Family Legacy Dental, Llc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 845 N 100 W, Orem, Utah |
| Authorized Official Name and Position | Lamona Marie Fullmer (OWNER) |
| Authorized Official Contact | 8012275080 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Legacy Dental, Llc 845 N 100 W Suite 100 Orem UT 84057-3180 Ph: (801) 227-5080 | Family Legacy Dental, Llc 845 N 100 W Suite 100 Orem UT 84057-3180 Ph: (801) 227-5080 |
| NPI Number | 1982721114 |
|---|---|
| Provider Enumeration Date | 03/23/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1982721114 | NPI | - | NPPES |
| 363064330001 | Medicaid | UT | |
| 475132674001 | Medicaid | UT | |
| 529361668001 | Medicaid | UT | |
| 529779405001 | Medicaid | UT | |
| 529636043001 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 5672963-0160 (Utah) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 5672963-0160 (Utah) | Primary |
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