Provider Demographics
NPI:1801388764
Name:O'DONNELL, KATE ELAINE (DMD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:ELAINE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 SANTIAGO ST
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2231
Mailing Address - Country:US
Mailing Address - Phone:319-610-4181
Mailing Address - Fax:
Practice Address - Street 1:5935 US HIGHWAY 27 N STE 103
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1200
Practice Address - Country:US
Practice Address - Phone:863-382-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN27828122300000X
OH30.025459122300000X
IADDS-09736122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist