Provider Demographics
NPI:1679363543
Name:FAMILY LEGACY DENTAL LLC
Entity type:Organization
Organization Name:FAMILY LEGACY DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:ROWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-227-5080
Mailing Address - Street 1:845 N 100 W STE 100
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3195
Mailing Address - Country:US
Mailing Address - Phone:801-227-5080
Mailing Address - Fax:801-227-5080
Practice Address - Street 1:845 N 100 W STE 100
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3195
Practice Address - Country:US
Practice Address - Phone:801-227-5080
Practice Address - Fax:801-227-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-12
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty