Healthcare Provider Details

I. General information

NPI: 1801887005
Provider Name (Legal Business Name): ODDS DENTAL SERVICES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CHEERFUL PL
LA VERGNE TN
37086-3608
US

IV. Provider business mailing address

101 CHEERFUL PL
LA VERGNE TN
37086-3608
US

V. Phone/Fax

Practice location:
  • Phone: 615-793-1242
  • Fax: 615-793-8189
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7854
License Number StateTN

VIII. Authorized Official

Name: DR. MARVO ODDS
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 615-793-1242