MEDICARE: KATE ELAINE O'DONNELL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN27828	FL
2	122300000X	Dentist	30.025459	OH
3	122300000X	Dentist	DDS-09736	IA

General Provider Information

NPI Number	:	1801388764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE ELAINE O'DONNELL DMD

Provider Business Mailing Address
First Line	:	3923 SANTIAGO ST
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33872-2231
Country	:	US
Telephone Number	:	319-610-4181
Fax Number	:

Provider Business Practice Location Address
First Line	:	5935 US HIGHWAY 27 N STE 103
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33870-1200
Country	:	US
Telephone Number	:	863-382-0888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2018
Last Update Date	:	05/09/2023

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