Healthcare Provider Details

I. General information

NPI: 1801806096
Provider Name (Legal Business Name): BRUCE T MURDOCK D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 E 20 S
AMERICAN FORK UT
84003-3834
US

IV. Provider business mailing address

356 E 20 S
AMERICAN FORK UT
84003-3834
US

V. Phone/Fax

Practice location:
  • Phone: 801-756-4595
  • Fax: 801-756-1827
Mailing address:
  • Phone: 801-756-4595
  • Fax: 801-756-1827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number144006
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: