Provider Demographics
NPI:1629326319
Name:ODOOM, NANA (DDS)
Entity Type:Individual
Prefix:DR
First Name:NANA
Middle Name:
Last Name:ODOOM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 OLD FARM LN STE B-3A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-4117
Mailing Address - Country:US
Mailing Address - Phone:571-225-7921
Mailing Address - Fax:
Practice Address - Street 1:200 BENT CREEK BLVD STE 3
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-1938
Practice Address - Country:US
Practice Address - Phone:717-589-4500
Practice Address - Fax:717-207-7060
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039358122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist