Provider Demographics
NPI:1912022377
Name:O'DONNELL, HAROLD DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:DAVID
Last Name:O'DONNELL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3689 BARROW WOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-6107
Mailing Address - Country:US
Mailing Address - Phone:859-543-9262
Mailing Address - Fax:
Practice Address - Street 1:1081 DOVE RUN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-3584
Practice Address - Country:US
Practice Address - Phone:859-269-4613
Practice Address - Fax:859-266-0588
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice