Provider Demographics
NPI:1437317146
Name:MCDONOUGH, DAVID R (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:MCDONOUGH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:6070 S 1300 E
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-6722
Mailing Address - Country:US
Mailing Address - Phone:801-266-2662
Mailing Address - Fax:801-268-2009
Practice Address - Street 1:6070 S 1300 E
Practice Address - Street 2:SUITE 202
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84121-6722
Practice Address - Country:US
Practice Address - Phone:801-266-2662
Practice Address - Fax:801-268-2009
Is Sole Proprietor?:No
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT674056699221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics