Provider Demographics
NPI:1194187534
Name:MARVO C. ODDS, DDS, P.C.
Entity Type:Organization
Organization Name:MARVO C. ODDS, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVO
Authorized Official - Middle Name:
Authorized Official - Last Name:ODDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-680-9460
Mailing Address - Street 1:1872 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2018
Mailing Address - Country:US
Mailing Address - Phone:931-680-9460
Mailing Address - Fax:
Practice Address - Street 1:1872 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2018
Practice Address - Country:US
Practice Address - Phone:931-680-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty