Provider Demographics
NPI:1205533049
Name:O'DONNELL, TATYANA ELAINE (RDH, IPDH, MSDH)
Entity type:Individual
Prefix:
First Name:TATYANA
Middle Name:ELAINE
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:RDH, IPDH, MSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 PINE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-9655
Mailing Address - Country:US
Mailing Address - Phone:207-615-6571
Mailing Address - Fax:
Practice Address - Street 1:15 PIPER RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-7575
Practice Address - Country:US
Practice Address - Phone:207-615-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4009124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist