NPIMap

Organization Active NPI

Family Legacy Dental, LLC

  • Pediatric Dentistry
  • Orem, UT
National Provider Identifier
1982721114
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
5672963-0160 Issued in UT
Legal business name
FAMILY LEGACY DENTAL, LLC
Practice address
845 N 100 W
Suite 100
Orem, UT 84057-3180
Phone
(801) 227-5080
NPI assigned
Mar 23, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Mrs. Lamona Marie Fullmer
Title
Owner
Phone
(801) 227-5080

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 5672963-0160 UT
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X 5672963-0160 UT Primary

Addresses

Primary practice location

845 N 100 W
Suite 100
Orem, UT 84057-3180

Mailing address

845 N 100 W
Suite 100
Orem, UT 84057-3180
Phone (801) 227-5080

Other identifiers 5

IdentifierTypeStateIssuer
363064330001MedicaidUT
475132674001MedicaidUT
529361668001MedicaidUT
529779405001MedicaidUT
529636043001MedicaidUT

National Provider Directory

National Provider Directory

Locations

845 N 100 W
Ste 100
Orem, UT 84057
Phone (801) 227-5080

NPI Registry JSON

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1982721114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N 100 W",
            "address_2": "SUITE 100",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840573180",
            "telephone_number": "801-227-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N 100 W",
            "address_2": "SUITE 100",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840573180",
            "telephone_number": "801-227-5080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY LEGACY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-23",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "FULLMER",
        "authorized_official_first_name": "LAMONA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-227-5080",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "5672963-0160",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "UT",
            "license": "5672963-0160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "363064330001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "475132674001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529361668001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529779405001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529636043001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 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.