Provider Demographics
NPI:1336712686
Name:ODONNELL, LINDSAY ROSE
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ROSE
Last Name:ODONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 APPLING DR UNIT 302
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-4796
Mailing Address - Country:US
Mailing Address - Phone:330-831-2434
Mailing Address - Fax:
Practice Address - Street 1:491 W BUTTERNUT RD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-5507
Practice Address - Country:US
Practice Address - Phone:843-419-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-22
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist