Healthcare Provider Details

I. General information

NPI: 1922218023
Provider Name (Legal Business Name): NORA A ODINGO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 SULLIVAN HL STONY BROOK DENTAL ASSOCIATES
STONY BROOK NY
11794-8705
US

IV. Provider business mailing address

127 WESTCHESTER HL STONY BROOK UNIVERSITY SCHOOL OF DENTAL MEDICINE
STONY BROOK NY
11794-8706
US

V. Phone/Fax

Practice location:
  • Phone: 631-632-8971
  • Fax:
Mailing address:
  • Phone: 631-632-8971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number050811-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: