| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |