Provider Demographics
NPI:1336573120
Name:DONAHOO, JAMES R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:DONAHOO
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 1:10894 S RIVER FRONT PARKWAY
Mailing Address - Street 2:BLDG 11
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095
Mailing Address - Country:US
Mailing Address - Phone:801-878-1406
Mailing Address - Fax:
Practice Address - Street 1:10894 S. RIVER FRONT PARKWAY
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095
Practice Address - Country:US
Practice Address - Phone:801-878-1406
Practice Address - Fax:801-878-1315
Is Sole Proprietor?:No
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359352-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice