Provider Demographics
NPI:1154153591
Name:OGDEN, CONNER JACK (DMD)
Entity type:Individual
Prefix:MR
First Name:CONNER
Middle Name:JACK
Last Name:OGDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 N 1075 W, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3066
Mailing Address - Country:US
Mailing Address - Phone:801-451-6222
Mailing Address - Fax:801-451-6262
Practice Address - Street 1:1838 N 1075 W, SUITE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3066
Practice Address - Country:US
Practice Address - Phone:801-451-6222
Practice Address - Fax:801-451-6262
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT139940571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice