Healthcare Provider Details

I. General information

NPI: 1629113220
Provider Name (Legal Business Name): DR. WILLIAM C.O'DONNELL DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 SOUTH ST
PITTSFIELD MA
01201-6811
US

IV. Provider business mailing address

262 SOUTH ST
PITTSFIELD MA
01201-6811
US

V. Phone/Fax

Practice location:
  • Phone: 413-443-0703
  • Fax: 413-443-0746
Mailing address:
  • Phone: 413-443-0703
  • Fax: 413-443-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number13078
License Number StateMA

VIII. Authorized Official

Name: MRS. THERESA L. JEROME
Title or Position: RECEPTIONIST
Credential:
Phone: 413-443-0703