Provider Demographics
NPI:1972542801
Name:ORAL HEALTH CENTER
Entity type:Organization
Organization Name:ORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:O'DONOGHUE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-969-1800
Mailing Address - Street 1:1951 W 4700 S
Mailing Address - Street 2:SUITE 5
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
Practice Address - Street 2:SUITE 5
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84118-1108
Practice Address - Country:US
Practice Address - Phone:801-969-1800
Practice Address - Fax:801-969-6223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT32520099221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty