Provider Demographics
NPI:1629113220
Name:DR. WILLIAM C.O'DONNELL DMD PC
Entity Type:Organization
Organization Name:DR. WILLIAM C.O'DONNELL DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JEROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-443-0703
Mailing Address - Street 1:262 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-6811
Mailing Address - Country:US
Mailing Address - Phone:413-443-0703
Mailing Address - Fax:413-443-0746
Practice Address - Street 1:262 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6811
Practice Address - Country:US
Practice Address - Phone:413-443-0703
Practice Address - Fax:413-443-0746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA159991OtherUNITED CONCORDIA
MAX11995OtherBC BS OF MASS
MA0250953Medicaid