Provider Demographics
NPI:1841317088
Name:ODOM, JAMES HUNTINGTON JR (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:HUNTINGTON
Last Name:ODOM
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 NORTH JEFFERSON AVE
Mailing Address - Street 2:WEST BATON ROUGE PARISH
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767
Mailing Address - Country:US
Mailing Address - Phone:225-343-2251
Mailing Address - Fax:225-387-1539
Practice Address - Street 1:227 NORTH JEFFERSON AVE
Practice Address - Street 2:WEST BATON ROUGE PARISH
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767
Practice Address - Country:US
Practice Address - Phone:225-343-2251
Practice Address - Fax:225-387-1539
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3446122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1834467Medicaid
LA980147OtherUNITED CONCORDIA
LAF1312OtherBCBS OF LA