Provider Demographics
NPI:1972629962
Name:JOSEPH ODEESH DDS,PC
Entity Type:Organization
Organization Name:JOSEPH ODEESH DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESEDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEESH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-365-4870
Mailing Address - Street 1:11451 JOSEPH CAMPAU ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3040
Mailing Address - Country:US
Mailing Address - Phone:313-365-4870
Mailing Address - Fax:313-365-4870
Practice Address - Street 1:11451 JOSEPH CAMPAU ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3040
Practice Address - Country:US
Practice Address - Phone:313-365-4870
Practice Address - Fax:313-365-4870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16831223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00-D-16825-00OtherBLUECROSS