Provider Demographics
NPI:1598833550
Name:O'DONNELL, SCOT A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:SCOT
Middle Name:A
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14362 W STATE HIGHWAY 29 STE 101
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-4902
Mailing Address - Country:US
Mailing Address - Phone:512-548-5040
Mailing Address - Fax:512-548-5042
Practice Address - Street 1:14362 W STATE HIGHWAY 29 STE 101
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-4902
Practice Address - Country:US
Practice Address - Phone:512-548-5040
Practice Address - Fax:512-548-5040
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073631107OtherNPI
TX1598833550OtherNPI- TYPE 1
TX47-0853393OtherTAX ID