Leonard R Odham Jr Dds Pa | |
16 Powell St Fair Bluff NC 28439 | |
(910) 649-7222 | |
(910) 649-7113 |
Full Name | Leonard R Odham Jr Dds Pa |
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Speciality | Dentist |
Location | 16 Powell St, Fair Bluff, North Carolina |
Authorized Official Name and Position | Leonard Russell Odham (PRES) |
Authorized Official Contact | 9106491222 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Leonard R Odham Jr Dds Pa Po Box 368 Fair Bluff NC 28439 Ph: (910) 649-7222 | Leonard R Odham Jr Dds Pa 16 Powell St Fair Bluff NC 28439 Ph: (910) 649-7222 |
NPI Number | 1063556587 |
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Provider Enumeration Date | 02/16/2007 |
Last Update Date | 05/29/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1063556587 | NPI | - | NPPES |
8996472 | Medicaid | NC |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 4101 (North Carolina) | Primary |