Provider Demographics
NPI:1093930752
Name:O'DONNELL, BRANDON HEATH (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:HEATH
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4720 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3134
Mailing Address - Country:US
Mailing Address - Phone:251-344-4994
Mailing Address - Fax:251-345-8872
Practice Address - Street 1:4720 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3134
Practice Address - Country:US
Practice Address - Phone:251-344-4994
Practice Address - Fax:251-345-8872
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL52061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice