Organization
LEONARD R ODHAM JR DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEONARD RUSSELL ODHAM JR. DDS (PRES)
(910) 649-1222
Entity
Organization
Contact information
Practice address
16 POWELL ST, FAIR BLUFF, NC 28439
(910) 649-7222
(910) 649-7113
Mailing address
PO BOX 368, FAIR BLUFF, NC 28439
(910) 649-7222
(910) 649-7113
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4101
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8996472
—
NC
Enumeration date
02/16/2007
Last updated
05/29/2012
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