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General NPI Number Information
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NPI Number | 1336150606
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Entity Type | Organization
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Legal Business Name | JAN ODELL DDS INC
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 27462 CALLE ARROYO SUITE 46B
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675
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Country | US
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Telephone | 949-443-9533
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Fax | 949-443-6123
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Provider Business Mailing Address
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Address Line | 27462 CALLE ARROYO SUITE 46B
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City | SAN JUAN CAPISTRANO
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State | CA
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Zip | 92675
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Country | US
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Telephone | 949-443-9533
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Fax | 949-443-6123
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSANNE M ODELL
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Credential | DDS
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Telephone | 949-443-9533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 39059
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License Number State | CA
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