Provider Demographics
NPI:1982838546
Name:O'DONNELL, JEAN A (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:A
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 1:3501 TERRACE ST
Mailing Address - Street 2:440 SALK HALL
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15261-1933
Mailing Address - Country:US
Mailing Address - Phone:412-648-8672
Mailing Address - Fax:412-383-7796
Practice Address - Street 1:3501 TERRACE ST
Practice Address - Street 2:440 SALK HALL
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15261-1933
Practice Address - Country:US
Practice Address - Phone:412-648-8672
Practice Address - Fax:412-383-7796
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027380L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1027635660001Medicaid