Provider Demographics
NPI:1790884237
Name:ODONO, LARRY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:M
Last Name:ODONO
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 1:3523 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-1540
Mailing Address - Country:US
Mailing Address - Phone:323-721-7993
Mailing Address - Fax:323-721-5571
Practice Address - Street 1:3523 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-1540
Practice Address - Country:US
Practice Address - Phone:323-721-7993
Practice Address - Fax:323-721-5571
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist