Provider Demographics
NPI:1457446221
Name:ODONNELL, ROBERT EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:ODONNELL
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 1:640 S WASHINGTON ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6603
Mailing Address - Country:US
Mailing Address - Phone:630-961-1779
Mailing Address - Fax:630-961-1882
Practice Address - Street 1:640 S WASHINGTON ST
Practice Address - Street 2:SUITE 360
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-6603
Practice Address - Country:US
Practice Address - Phone:630-961-1779
Practice Address - Fax:630-961-1882
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics