NPI 1144163833

Brightside Oral Surgery LLC

Organisation Oral & Maxillofacial Surgery (D.M.D.) Syracuse, UT

Practice location

Address: 1562 S 3000 W STE 100, Syracuse, UT 84075-2003
Phone: (801) 773-8644
Fax: (801) 773-9828

Authorised official

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

Registered specialties

Oral & Maxillofacial Surgery (D.M.D.) Primary

Allopathic & Osteopathic Physicians Taxonomy 204E00000X

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Registry record

NPI: 1144163833
Entity type: Organization
NPI issued: 9 Apr 2026
Record last updated: 9 Apr 2026

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.