NPIMap

Organization Active NPI

Families First Pediatric Dentistry

  • Pediatric Dentistry
  • Riverton, UT
National Provider Identifier
1700464955
Registry record updated Jul 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
FAMILIES FIRST PEDIATRIC DENTISTRY
Practice address
4651 W 13400 S Ste 110
Riverton, UT 84096-6483
Phone
(801) 450-1250
NPI assigned
Mar 30, 2021
Last updated
Jul 1, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ebonie Gonzales
Title
Credentialing Specialist
Phone
(505) 850-3769

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Dentistry 1223P0221X NU Primary

Addresses

Primary practice location

4651 W 13400 S Ste 110
Riverton, UT 84096-6483

Mailing address

PO Box 95868
South Jordan, UT 84095-0868
Phone (801) 450-1250

Other practice location 1

1597 Woodland Park Dr Ste 200
Layton, UT 84041-5696
Phone (801) 544-1940

Other practice location 2

13825 S Redwood Rd Ste 100
Bluffdale, UT 84065-5241
Phone (801) 515-5858

Other practice location 3

1792 W 1700 S Ste 101
Syracuse, UT 84075-9650
Phone (801) 614-0099

Other practice location 4

5459 W 7800 S # 100
West Jordan, UT 84081-6023
Phone (801) 515-5858

Other practice location 5

5136 N Cambridge Way
Stansbury Park, UT 84074
Phone (801) 515-5858

Other practice location 6

1320 W South Jordan Pkwy
South Jordan, UT 84095-8847
Phone (801) 254-9700

Other identifiers 5

IdentifierTypeStateIssuer
1932399391MedicaidUT
1013479492MedicaidUT
1811237076MedicaidUT
1215379540MedicaidUT
1831165224MedicaidUT

National Provider Directory

National Provider Directory
Tax ID family
Families First Pediatric Dentistry8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

4651 W 13400 S
Ste 110
Riverton, UT 84096
Phone (801) 450-1250

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1617062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751328000000",
    "number": "1700464955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95868",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840950868",
            "telephone_number": "801-450-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4651 W 13400 S STE 110",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840966483",
            "telephone_number": "801-450-1250"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1597 Woodland Park Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Layton",
            "state": "UT",
            "postal_code": "840415696",
            "country_code": "US",
            "telephone_number": "801-544-1940",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13825 S Redwood Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Bluffdale",
            "state": "UT",
            "postal_code": "840655241",
            "country_code": "US",
            "telephone_number": "801-515-5858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1792 W 1700 S Ste 101",
            "address_purpose": "LOCATION",
            "city": "Syracuse",
            "state": "UT",
            "postal_code": "840759650",
            "country_code": "US",
            "telephone_number": "801-614-0099",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5459 W 7800 S # 100",
            "address_purpose": "LOCATION",
            "city": "West Jordan",
            "state": "UT",
            "postal_code": "840816023",
            "country_code": "US",
            "telephone_number": "801-515-5858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5136 N Cambridge Way",
            "address_purpose": "LOCATION",
            "city": "Stansbury Park",
            "state": "UT",
            "postal_code": "84074",
            "country_code": "US",
            "telephone_number": "801-515-5858",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1320 W South Jordan Pkwy",
            "address_purpose": "LOCATION",
            "city": "South Jordan",
            "state": "UT",
            "postal_code": "840958847",
            "country_code": "US",
            "telephone_number": "801-254-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FAMILIES FIRST PEDIATRIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-30",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A",
        "authorized_official_last_name": "GONZALES",
        "authorized_official_first_name": "EBONIE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "505-850-3769"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932399391",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013479492",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811237076",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215379540",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1831165224",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverton, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.