Provider Demographics
NPI:1235554684
Name:ODOM, WILLIAM III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:ODOM
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:330 REDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-4055
Mailing Address - Country:US
Mailing Address - Phone:650-533-9967
Mailing Address - Fax:760-729-6952
Practice Address - Street 1:5256 S MISSION RD
Practice Address - Street 2:1101
Practice Address - City:BONSALL
Practice Address - State:CA
Practice Address - Zip Code:92003-3614
Practice Address - Country:US
Practice Address - Phone:760-576-5695
Practice Address - Fax:760-729-6952
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA178501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics