Brightside Oral Surgery LLC
Organization Active NPI Oral & Maxillofacial Surgery (D.M.D.) · Roy, UT
NPI 1083569396 · NPPES record last updated Mar 2, 2026
Key facts
- NPI
- 1083569396
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Oral & Maxillofacial Surgery (D.M.D.) 204E00000X
- Legal business name
- BRIGHTSIDE ORAL SURGERY LLC
- Practice address
- 5682 S 3500 W Unit a
Roy, UT 84067-9108 - Phone
- (801) 773-9828
- Fax
- (801) 773-9828
- NPI assigned
- Mar 2, 2026
- Organization subpart
- No
Authorized official
- Name
- Ebonie Gonzales
- Title
- Credentialing Manager
- Phone
- (505) 850-3769
Corporate family (same tax ID) 2
National Provider Directory
- Tax ID family
- Brightside Oral Surgery LLC
Locations
5682 S 3500 W
Unit A
Roy, UT 84067
Phone (801) 773-9828
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral & Maxillofacial Surgery (D.M.D.) |
204E00000X | Yes |
Addresses
Primary practice location
5682 S 3500 W Unit a
Roy, UT 84067-9108
Mailing address
5682 S 3500 W Unit a
Roy, UT 84067-9108
Phone (801) 773-9828
Other providers in Roy, UT
- Brian Borg
- Mary Milner Boyette
- Breen Family Medicine, PLLC
- Annamarie Irene Breen
- Robert Joseph Bright
- Karleen Broadwater
- Henry Brower
- Haiden Brown-Lassig
- Gerald H. Brown
- Joshua Brown
All providers in Roy, UT · Oral & Maxillofacial Surgery (D.M.D.) in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.