MEDICARE: JERROD ODETTE DENTAL PLLC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1851254684
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERROD ODETTE DENTAL PLLC

Provider Business Mailing Address
First Line	:	14846 HAZEL LEAF CT
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75707-6725
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 ABERDEEN DR
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-1943
Country	:	US
Telephone Number	:	903-574-0275
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	JERROD RYAN ODETTE
Credential	:	DDS
Telephone Number	:	903-574-0275

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/08/2025

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Directions to “JERROD ODETTE DENTAL PLLC ” Practice Location

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