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General NPI Number Information
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NPI Number | 1548797590
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Entity Type | Organization
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Legal Business Name | SEAN O'DELL DDS PLLC
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Dates
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Enumeration Date | 05/20/2017
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Last Update Date | 05/20/2017
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Provider Practice Location Address
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Address Line | 6 S BROADWAY
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City | WATERTOWN
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State | SD
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Zip | 57201-3604
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Country | US
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Telephone | 605-641-3586
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Fax |
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Provider Business Mailing Address
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Address Line | 6 S BROADWAY
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City | WATERTOWN
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State | SD
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Zip | 57201-3604
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | SEAN O'DELL
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Credential |
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Telephone | 605-641-3586
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D1018
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License Number State | SD
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