Provider Demographics
NPI:1851772453
Name:ODENS, CARLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLEY
Middle Name:
Last Name:ODENS
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 1:241 CLEVELAND AVE S STE 1D
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-1255
Mailing Address - Country:US
Mailing Address - Phone:651-699-3212
Mailing Address - Fax:651-698-8898
Practice Address - Street 1:241 CLEVELAND AVE S STE 1D
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55105-1255
Practice Address - Country:US
Practice Address - Phone:651-699-3212
Practice Address - Fax:651-698-8898
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13542122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist