Provider Demographics
NPI:1467491373
Name:O'DONOGHUE, BRUCE J (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:J
Last Name:O'DONOGHUE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 W 4700 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84118-1108
Mailing Address - Country:US
Mailing Address - Phone:801-969-1800
Mailing Address - Fax:801-969-6223
Practice Address - Street 1:1951 W 4700 S STE 5
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1108
Practice Address - Country:US
Practice Address - Phone:801-969-1800
Practice Address - Fax:801-969-6223
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325200-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice