Provider Demographics
NPI:1336347343
Name:ODEH, OSAMA (BDS)
Entity Type:Individual
Prefix:
First Name:OSAMA
Middle Name:
Last Name:ODEH
Suffix:
Gender:M
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 PATRIOT HWY
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9422
Mailing Address - Country:US
Mailing Address - Phone:540-479-2764
Mailing Address - Fax:540-479-2917
Practice Address - Street 1:9821 PATRIOT HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-9422
Practice Address - Country:US
Practice Address - Phone:540-479-2764
Practice Address - Fax:540-479-2917
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND118981223G0001X
VA04014119011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice