MEDICARE: DR. DAVID R. MCDONOUGH D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	67405669922	UT

General Provider Information

NPI Number	:	1437317146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID R. MCDONOUGH D.D.S.

Provider Business Mailing Address
First Line	:	6070 S 1300 E
Second Line	:	SUITE 202
City	:	MURRAY
State	:	UT
Zip	:	84121-6722
Country	:	US
Telephone Number	:	801-266-2662
Fax Number	:	801-268-2009

Provider Business Practice Location Address
First Line	:	6070 S 1300 E
Second Line	:	SUITE 202
City	:	MURRAY
State	:	UT
Zip	:	84121-6722
Country	:	US
Telephone Number	:	801-266-2662
Fax Number	:	801-268-2009

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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Directions to “ DR. DAVID R. MCDONOUGH D.D.S.” Practice Location

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