Provider Demographics
NPI:1295845139
Name:O'DELL, VAN S (DDS)
Entity Type:Individual
Prefix:DR
First Name:VAN
Middle Name:S
Last Name:O'DELL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 CRESTWOOD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:N LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7616
Mailing Address - Country:US
Mailing Address - Phone:501-758-5006
Mailing Address - Fax:501-758-2173
Practice Address - Street 1:2501 CRESTWOOD RD
Practice Address - Street 2:STE 201
Practice Address - City:N LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-6864
Practice Address - Country:US
Practice Address - Phone:501-758-5006
Practice Address - Fax:501-758-2173
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR21031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice