Healthcare Provider Details

I. General information

NPI: 1053376525
Provider Name (Legal Business Name): JOSEPH H ODEESH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11451 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3040
US

IV. Provider business mailing address

11451 JOSEPH CAMPAU ST
HAMTRAMCK MI
48212-3040
US

V. Phone/Fax

Practice location:
  • Phone: 313-365-4870
  • Fax: 313-365-5470
Mailing address:
  • Phone: 313-365-4870
  • Fax: 313-365-5470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901016825
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: