Provider Demographics
NPI:1770653065
Name:ODEH, JAMEL DEEB (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMEL
Middle Name:DEEB
Last Name:ODEH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4302 SHOAL CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8668
Mailing Address - Country:US
Mailing Address - Phone:336-393-0219
Mailing Address - Fax:336-294-2323
Practice Address - Street 1:4119 WALKER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-1315
Practice Address - Country:US
Practice Address - Phone:336-294-2322
Practice Address - Fax:336-294-2323
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC96473OtherBCBS #
NC6996473Medicaid