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General NPI Number Information
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NPI Number | 1093884074
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Entity Type | Organization
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Legal Business Name | HARLEY ODDEN DDS, INC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 40739 GRIMMER BLVD
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City | FREMONT
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State | CA
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Zip | 94538-2800
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Country | US
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Telephone | 510-651-1440
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Fax | 510-651-1454
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Provider Business Mailing Address
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Address Line | 40739 GRIMMER BLVD
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City | FREMONT
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State | CA
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Zip | 94538-2800
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Country | US
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Telephone | 510-651-1440
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Fax | 510-651-1454
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HARLEY SCOTT ODDEN
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Credential | DDS
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Telephone | 510-651-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | FNP 2586
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License Number State | CA
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