Provider Demographics
NPI:1326300955
Name:O'DELL, JOSHUA EDWARD (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:EDWARD
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 1:2335 KNOB CREEK RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2002
Mailing Address - Country:US
Mailing Address - Phone:423-282-1030
Mailing Address - Fax:423-282-4714
Practice Address - Street 1:2335 KNOB CREEK RD
Practice Address - Street 2:SUITE 107
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2002
Practice Address - Country:US
Practice Address - Phone:423-282-1030
Practice Address - Fax:423-282-4714
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN94661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice