Healthcare Provider Details

I. General information

NPI: 1588507222
Provider Name (Legal Business Name): HAYDEN MICHAEL ODELL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N. 11TH STREET
RICHMOND VA
23219
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0602
  • Fax: 804-593-4279
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number0442000579
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: