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General NPI Number Information
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NPI Number | 1073987038
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Entity Type | Organization
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Legal Business Name | LIZZIE O'DELL PLLC
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 3520 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9479
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Country | US
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Telephone | 334-538-1390
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Fax |
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Provider Business Mailing Address
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Address Line | 3520 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9479
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Country | US
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Telephone | 334-538-1390
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELIZABETH PHAM O'DELL
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Credential | DMD
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Telephone | 334-538-1390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4042
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License Number State | WV
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