Provider Demographics
NPI:1649630534
Name:O'DELL, JOSANNE MILDRED (DDS)
Entity type:Individual
Prefix:
First Name:JOSANNE
Middle Name:MILDRED
Last Name:O'DELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 STEEPLEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5075
Mailing Address - Country:US
Mailing Address - Phone:714-267-5205
Mailing Address - Fax:
Practice Address - Street 1:2060 STEEPLEBROOK DR
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5075
Practice Address - Country:US
Practice Address - Phone:714-267-5205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN99701223E0200X
CA390591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics